Hounsfield Unit Average Calculation Research Articles

Pre-injury sarcopenia and the association with discharge destination in critical care trauma patients

Background Sarcopenia is a key physical component in the aetiology of frailty, representing progressive and CT-quantifiable muscle mass loss. In older trauma patients admitted to critical care, sarcopenic defined-frailty is associated with adverse outcomes, including poor function at discharge. This may complicate discharge to the usual place of residence, an important outcome for patients. This study aimed to identify pre-injury sarcopenia in all trauma patients admitted to critical care and investigate factors associated with discharge destination. Methods We performed a retrospective analysis of adult trauma patients admitted to a Major Trauma Centre (Level 1 equivalent) over 18 months. Psoas muscle density (PMD) was measured at the level of L4 vertebra from admission computerised tomography (CT) abdomen/pelvis. Sarcopenia was defined as the PMD calculated using Hounsfield unit average calculation within the lowest quartile for sex. Discharge destination was dichotomised into independent and dependent discharge. Multivariable logistic regression was used to determine factors associated with discharge destination. Results Overall, 197 patients were included. Patients were predominantly male (73%) with a median age of 52 (32–72) and the majority were severely injured (72%). Sarcopenia was identified in a quarter of the cohort on admission to critical care ( n = 49). Only a third of sarcopenic patients were discharged to home, compared to a half of non-sarcopenic patients ( p = 0.03). Sarcopenia (OR 0.30; 95% CI 0.17–0.81, p = 0.01), blunt injury (OR 0.22; 95% CI 0.06–0.87, p = 0.03), age (OR 0.97; 95% CI 0.95–0.99, p = 0.01) and Multiple Organ Dysfunction Syndrome (OR 0.24; 95% CI 0.12–0.57, p = 0.01) were associated with a decreased rate of independent discharge. Conclusion For trauma critical care patients, sarcopenia on admission CT was associated with dependent discharge destination and therefore is unfavourable. Defining sarcopenia early in an trauma patients critical care admission may help to identify those at risk of poor outcomes.

Initial values of skeletal muscle parameters in patients presenting with acute pancreatitis

Objective: Predicting the clinical course of acute pancreatitis has been discussed previously on the basis of visceral adipose tissue. This study was conducted to determine the relationship between clinical outcomes of acute pancreatitis and changes in skeletal muscle parameters.
 Method: This is a single-center, cross-sectional, retrospective study. Patients who were diagnosed with acute pancreatitis between 01-28 February 2019 and had abdominal computed tomography (CT) taken in the first week of their hospitalization were included in the study. L3 level of abdominal CT images were used to evaluate skeletal muscle parameters.
 Results: During the hospital database scanning, 127 patients newly diagnosed with acute pancreatitis were included in the study. The median age was 50 (18-88) years, 47% were male, and 53% were female. The median body mass index (BMI) was 26,42 (19.4-46.8) kg/m2. Fifty-one % of patients were diagnosed with biliary acute pancreatitis, and 48.8% were diagnosed with non-biliary acute pancreatitis. At the same time, acute pancreatitis severity was classified according to revised Atlanta criteria, 67.7% were mild (n = 86), 28.3% were moderate (n = 36) and 5 (3.9%) patients were severe. Skeletal muscle mass was evaluated using the total psoas index (TPI) and, skeletal muscle density calculated by HU. Median TPI was 6.3 (2.5-13.7). The median of Hounsfield Unit (HU) average calculation was 18.9 (3.8-28.5) (Table 1). There were no statistically significant differences on sex, age, BMI, skeletal muscle parameters, and acute pancreatitis clinical outcome (Table 2).
 Conclusion: Skeletal muscle parameters determined by TPI and HU were not a predictor of the clinical course, and viewing them always cannot effectively investigate their effect on acute pathologies. So, this way couldn't be proposed as a perfect method for predicting the clinical outcome of acute pancreatitis.

Effect of Sarcopenia on Mortality and Morbidity in Patients With Fournier's Gangrene.

Preoperative sarcopenia is an essential factor that negatively affects postoperative results. The effect of preoperative sarcopenia on postoperative complications and prognosis in patients treated for Fournier's gangrene (FG) is controversial. This retrospective cohort study analyzed the effect of FG to evaluate the effect of preoperative sarcopenia on postoperative complications and prognosis in patients who were operated on. The data of patients who were operated on with FG diagnosis in our clinic between 2008 and 2020 were reviewed retrospectively. Demographic data (age and gender), anthropometric measurements, preoperative laboratory values, abdominopelvic CT, location of FG, number of debridements, ostomy, microbiological culture result, wound closure method, length of hospital stay, and overall survival were recorded. In addition, the presence of sarcopenia was determined according to psoas muscular index (PMI) and Hounsfield unit average calculation (HUAC). Of the patients, 57 (30.8%) were female and 128 (69.2%) were male. According to the PMI, sarcopenia was detected in 67 (36.2%) patients and 70 (37.8%), according to the HUAC. At the end of one postoperative year, the mortality rate was higher in the sarcopenia group than in the non-sarcopenia group (P = .002, P = .01). According to the PMI, patients with sarcopenia have an 8.17 times greater risk of exitus than non-sarcopenic patients. According to the HUAC, patients with sarcopenia have a 4.21 times greater risk of exitus than non-sarcopenic patients. Based on this large retrospective study, sarcopenia is a strong and independent predictor of postoperative mortality after Fournier's treatment for gangrene.

Sarcopenia of kidney transplant recipients as a predictive marker for reduced graft function and graft survival after kidney transplantation

PurposeThe association between sarcopenia of kidney transplant recipients and outcome after kidney transplantation (KT) has not yet been fully understood and is still considered controversial. The aim of our study was to analyze the impact of pre-transplant sarcopenia on graft function, postoperative complication rates, and survival of the patients after renal transplantation.MethodsIn this retrospective single-center study, all patients who underwent KT (01/2013–12/2017) were included. Demographic data, rejection rates, delayed graft function, and graft and patient survival rates were analyzed. Sarcopenia was measured in computed tomography images by the sex-adjusted Hounsfield unit average calculation (HUAC).ResultsDuring the study period, 111 single KTs (38 women and 73 men) were performed. Living donor kidney transplants were performed in 48.6%. In total, 32.4% patients had sarcopenia. Sarcopenic patients were significantly older (59.6 years vs. 49.8 years; p < 0.001), had a higher body mass index (BMI = 27.6 kg/m2 vs. 25.0 kg/m2; p = 0.002), and were more likely to receive deceased donor kidneys (72.2% vs. 41.3%; p = 0.002). Interestingly, 3 years after KT, the creatinine serum levels were significantly higher (2.0 mg/dl vs. 1.5 mg/dl; p = 0.001), whereas eGFR (39.9 ml/min vs. 53.4 ml/min; p = 0.001) and graft survival were significantly lower (p = 0.004) in sarcopenic transplant recipients. Sarcopenic patients stayed in hospital significantly longer postoperatively than those who were non-sarcopenic.ConclusionsAt the time of kidney transplantation, sarcopenia was found to predict reduced long-term graft function and diminished graft survival after KT. The early identification of sarcopenic patients can not only enable an optimized selection of recipients, but also the initiation of pre-habilitation programs during the waiting period.

Study of Post-Kidney Transplantation Parietal Complications and Presarcopenia

Sarcopenia is defined as a loss of muscle mass and strength. Its effects on postoperative outcomes in oncology and geriatrics have already been shown. Approximately 40% of patients in end-stage renal failure are affected with sarcopenia. A recent study suggests that sarcopenia could predict surgical complications after renal transplantation in obese patients. The aim of this study was to evaluate the effect of sarcopenia on parietal complications (eg, wound healing, lymphocele, hematoma). Two indices of muscle fat infiltration (intra-muscular adipose content [IMAC], Hounsfield unit average calculation [HUAC]) and 3 of muscle mass index (total psoas index [TPI], visceral fat area/total abdominal muscle area [VFA/TAMA], and skeletal muscle mass index [SMMI]) were retrospectively measured on pretransplant computed tomography scans for patients undergoing kidney transplantation between 2007 and 2017. Patients were considered sarcopenic when the index was above the third quartile for muscle fat infiltration (IMAC, HUAC) and VFA/TAMA, and under the first quartile for muscle mass (TPI, SMMI). The occurrence of wound healing, collection (hematoma and lymphocele), and acute rejection were compared between sarcopenic and nonsarcopenic patients. Of 484 transplanted patients, 117 patients had a computed tomography scan before transplantation. Patients with a high HUAC had significantly more collections (P=.02) and total parietal complications (P=.09). Patients with a high IMAC had significantly more acute rejection (P=.001). Muscle fat infiltration appears to influence the outcome of renal transplantation. The management of sarcopenia in pretransplantation should be a subject of further research.

Relationship between the Properties of Paraspinal Muscles and Bone Mineral Density in Osteoporotic Patients.

To investigate the properties of paraspinal muscle structures in osteoporotic patients, lumbar computed tomography (CT) and their relationship with lumbar and femoral neck bone mineral density (BMD). A Descriptive study. Department of Radiology and Physical Medicine, Istanbul Medeniyet University, Goztepe Prof Dr Suleyman Yalcin City Hospital, Istanbul, Turkey, between June 2020 and June 2021. Ninety patients with osteoporosis, who received lumbar spine CT and dual-energy X-ray absorptiometry (DEXA) examinations, were retrospectively included. Cross-sectional areas (CSA), densities, index values, and Hounsfield unit average calculation(HUAC) values were measured for psoas, multifidus, erector spinae, and quadratus lumborum muscles at the L3 level, and their associations with BMD were investigated. A total of 90 patients including 71 females were evaluated. The mean age was 63.31±11.90 years. A moderate correlation of lumbar spine (r=0.32, p<0.01) and femur neck BMD (r=0.28, p<0.05) with erector spinae CSA was defined. Small correlation between psoas CSA (r=0.28, p<0.05) and psoas muscle index (PMI, r=0.24, p<0.05) with lumbar spine BMD was found. The CSA of all the paraspinal muscles (p<0.01) and densities, except psoas muscle (p<0.05), were higher in males. In non-obese osteoporotic patients, the density and HUAC values of the paraspinal muscles, except the psoas muscle, were found to be significantly higher (p<0.05). The properties of the paraspinal muscles measured by the lumbar CT scan are found to be related to BMD. The psoas and erector spinae CSA and index values are the most significantly associated parameters with the lumbar spine BMD. Bone mineral density, Computed tomography, Osteoporosis, Paraspinal muscles, Psoas.

Sarcopenic obesity in early breast cancer patients with metabolic syndrome: a cross-sectional study.

Aim: The importance of sarcopenic obesity (SO) in malignancy has recently been recognized. The authors aimed to investigate the clinical and body composition data of early-stage breast cancer (BC) patients by focusing on the components of metabolic syndrome (MetS) and SO. Methods: In this cross-sectional study withearly-stage BC patients, the clinical and laboratory results were evaluated for diagnosing MetS. Bioimpedance analysis and muscle radiation attenuation (Hounsfield unit average calculation [HUAC]) using acquired computed tomography images were used to assess SO. Results: The age at diagnosis, BMI, visceral fat ratio, hemoglobin A1c and CEA levels in patients with MetS were significantly higher (p<0.05). A cutoff value of 39.4 Hounsfield units was significantly related to MetS with 76.5% sensitivity and 62% specificity. The mean HUAC in patients with MetS (36.9) was significantly lower than in those without MetS (41.4; p=0.017). Conclusion: HUAC value predicted SO in early-stage BC patients with MetS.

A Novel Technique for Radiographic Diagnosis of Sarcopenia that Accurately Predicts Postoperative Complications in Lower Extremity Free Flap Patients.

Sarcopenia is linked to poor outcomes throughout the surgical literature and can be assessed on preoperative imaging to potentially aid in risk stratification. This study examined the effects of sarcopenia on surgical morbidity following lower extremity (LE) reconstruction, and also compared two methods of assessment, one of which is novel ("ellipse method"). A retrospective cohort study of 50 patients receiving free flap-based reconstruction of the LE was performed. Bilateral psoas density and area were quantified at L4 through tracing ("traditional method") and encircling ("ellipse method") to calculate Hounsfield unit average calculation (HUAC). Logistic regression and receiving operator curve analysis for the primary outcome of any postoperative complication was used to determine HUAC cutoffs (≤ 20.7 vs. ≤ 20.6) for sarcopenia. Risk of complications associated with sarcopenia was evaluated using Fisher's exact tests. Twelve patients (24%) met criteria for sarcopenia via the traditional method and 16 (32%) via the ellipse method. By both methods, sarcopenic patients were older and more often female and diabetic. These patients also had higher American Society of Anesthesiologists scores and lower serum prealbumin levels. The ellipse method was found to be more accurate, sensitive, and specific than the traditional method in predicting postoperative morbidity (p = 0.009). Via the ellipse method, sarcopenic patients were at higher risk for any complication (p = 0.002) and were at a higher risk for a deep vein thrombus or pulmonary embolism via the traditional method (p = 0.047). Sarcopenia is associated with greater pre- and postoperative morbidity in LE reconstruction. The novel ellipse method is a simplified and accurate method of assessing sarcopenia that can be easily performed in the clinical setting.

Sarcopenia as a predictor of postoperative complications in patients with pancreatic cancer

Several studies showed that sarcopenia is associated with an increase of postoperative complications, with worse postoperative results in patients with pancreatic cancer. According to European Working Group on Sarcopenia, it is a "progressive and generalized skeletal muscle loss" characterized by both loss of skeletal muscle mass and strength (Cruz-Jentoft AJ et al., 2019). Aim of our work was to evaluate the effect of sarcopenia on the occurrence of postoperative complications after pancreatic resections in patients with pancreatic and periampullary cancer. We performed a retrospective analysis of treatment of 152 patients who underwent radical pancreatic resections. Sarcopenia was determined by preoperative computed tomography using the Hounsfield Unit Average Calculation (HUAC). In our investigation we measured the psoas area and density (Hounsfield Units) at the level of the third lumbar vertebral body (L3). Sarcopenia was diagnosed in 66 (43.4%) patients. Among patients with sarcopenia complications occurred in 41 (62.1%), mortality was 4 (6.1%). In the group of patients without sarcopenia, complications occurred in 29 (33.7%) of 86 patients, mortality was 2 (2.3%). The level of postoperative complications in patients with sarcopenia was significantly higher (c2 =12.1, p=0.0005). Postoperative mortality in patients with sarcopenia was higher without significant difference (c2 =1.3, p=0.24). Sarcopenia significantly affects the level of postoperative complications and its detection can be used to improve the selection of patients before pancreatic resections in patients with pancreatic cancer.

Effect of muscle density in patients with metastatic prostate cancer administered androgen deprivation therapy

IntroductionSarcopenia is a syndrome characterized by the loss of muscle mass and strength. The study objective was to determine the association between muscle density and overall survival (OS) in patients with metastatic onset prostate cancer (MPCa). Patients and methodsThis was a retrospective study of patients diagnosed with MPCa between 2009 and 2015 who received androgen deprivation therapy alone as initial treatment. Muscle density was calculated using the Hounsfield Unit Average Calculation (HUAC) in both psoas muscles in the computed tomography (CT) scan performed for diagnosis. ResultsA total of 59 patients diagnosed with MPCa, with a mean age of 57.5±72.47 years, were found. Median PSA level at diagnosis was 68.25ng/dl (IQR 37.26-290). Gleason scores ≥8 were recorded in 90.75% of the patients, bone metastases in 88.13%, and visceral metastases in 10.16%. Median HUAC was 20.32 HU (IQR 15.46–22.83).In a univariate analysis, the number of bone metastases, the presence of visceral metastases, and testosterone levels ≥50ng/dl at follow-up were associated with poorer OS, while high HUAC levels were associated with better OS. In a multivariate analysis, the number of bone metastases [hazard ratio (HR)=1.573, 95% confidence interval (CI)=1.103–2.243, p=0.012], the presence of visceral metastases (HR=7.404, CI=2.233–24.549, p=0.001), and the Gleason score (HR=2.001, CI=1.02–3.923, p=0.044) were associated with greater overall mortality, and HUAC (HR=0.902, CI=0.835–0.973, p=0.008) was associated with better OS. ConclusionsIn our series, increased HUAC values in the psoas muscles, as a reflection of muscle density, when MPCa was diagnosed had a protective effect on OS in these patients.

Dynamic frailty: Objective physiological assessment to guide management in necrotizing pancreatitis

BackgroundPhysical frailty as a measure of physiological reserve is an important yet understudied topic in necrotizing pancreatitis. We measured frailty metrics in patients with necrotizing pancreatitis at baseline and at 1 month to assess dynamic change. We hypothesized that greater baseline frailty and steeper decline in frailty biomarkers are associated with worse outcomes in necrotizing pancreatitis. MethodsA retrospective analysis of an institutional, necrotizing pancreatitis-specific database was performed. First order outcomes were organ failure, infected necrosis, step-up approach failure, and mortality. Baseline frailty assessment included measurement of comorbid diseases (modified frailty index), nutritional status (prognostic nutritional index), and radiologic sarcopenia (psoas muscle index, Hounsfield unit average calculation). Dynamic frailty was evaluated using psoas muscle index and Hounsfield unit average calculation. Significant associations between baseline and dynamic frailty with outcomes were analyzed. ResultsThree hundred and forty-one patients were included in this study. Most patients were male (65%) with biliary etiology of necrotizing pancreatitis (46%). Baseline comorbid diseases and baseline sarcopenia were not associated with first order outcomes. Lower baseline prognostic nutritional index was associated with organ failure (P < .001) and infected necrosis (P < .001). After 30 days, 25% of patients became sarcopenic. Larger declines in all sarcopenia metrics were associated with organ failure, infected necrosis, and/or death (P < .05). Lower psoas area and density were independent risk factors for organ failure and infected necrosis. ConclusionDynamic changes in sarcopenia-focused frailty metrics were significantly and consistently associated with organ failure, infected necrosis, and death. Further development of a dynamic frailty index to objectively guide decision-making in necrotizing pancreatitis is warranted.

Efecto de la densidad muscular en pacientes con cáncer de próstata metastásico tratados con terapia de privación androgénica

IntroductionSarcopenia is a syndrome characterized by the loss of muscle mass and strength. The study objective was to determine the association between muscle density and overall survival (OS) in patients with metastatic onset prostate cancer (MPCa). Materials and MethodsThis was a retrospective study of patients diagnosed with MPCa between 2009 and 2015 who received androgen deprivation therapy alone as initial treatment. Muscle density was calculated using the Hounsfield Unit Average Calculation (HUAC) in both psoas muscles in the computed tomography (CT) scan performed for diagnosis. ResultsA total of 59 patients diagnosed with MPCa, with a mean age of 57.5±72.47 years, were found. Median prostate-specific antigen (PSA) level at diagnosis was 68.25 ng/dL (IQR 37.26-290). Gleason scores≥8 were recorded in 90.75% of the patients, bone metastases in 88.13%, and visceral metastases in 10.16%. Median HUAC was 20.32 HU (IQR 15.46-22.83).In a univariate analysis, the number of bone metastases, the presence of visceral metastases, and testosterone levels≥50 ng/dL at follow-up were associated with poorer OS, while high HUAC levels were associated with better OS. In a multivariate analysis, the number of bone metastases [hazard ratio (HR)=1.573, 95% confidence interval (CI)=1.103-2.243, p=0.012], the presence of visceral metastases (HR=7.404, CI=2.233-24.549, p=0.001), and the Gleason score (HR=2.001, CI=1.02-3.923, p=0.044) were associated with greater overall mortality, and HUAC (HR=0.902, CI=0.835-0.973, p=0.008) was associated with better OS. ConclusionsIn our series, increased HUAC values in the psoas muscles, as a reflection of muscle density, when MPCa was diagnosed had a protective effect on OS in these patients.

Computed Tomography-Measured Psoas Muscle Density as a Predictive Factor for Hypophosphatemia Associated With Refeeding.

Initiation of parenteral nutrition (PN) after a period of starvation can be complicated by refeeding syndrome (RFS). RFS is associated with electrolyte abnormalities including hypomagnesemia, hyponatremia, and hypophosphatemia. Risk factors include recent weight loss, low body mass index, and electrolyte deficiencies; however, these associations are not strong. We hypothesized that a validated measure of nutrition risk, computed tomography (CT)-measured psoas muscle density, can be used to predict the development of hypophosphatemia associated with RFS. A retrospective analysis of surgical patients initiated on PN with an abdominal CT scan within the past 3 months was conducted. CT-measured psoas muscle density was assessed as a predictive variable for the development of electrolyte abnormalities. Daily electrolyte and clinical outcome measures were recorded. One hundred nine patients were stratified based on Hounsfield unit average calculation (HUAC). The lowest 25th percentile of patients had HUAC <25. Low HUAC was associated with a significant percent decrease in phosphate levels from baseline to PN day 3 (P < .01) and significant difference in serum phosphate value on PN day 3 (P < .01). The low muscle density quartile also experienced longer days on the mechanical ventilator (P = .01) compared with patients with a higher psoas muscle density. Psoas muscle density predicted the development of hypophosphatemia in patients initiated on PN. This measurement may aid in identifying patients at highest risk of experiencing RFS. Amean psoas HU <25 may prompt additional precautions, including additional phosphate replacement and slower initiation of PN.

Prognostic value of sarcopenia in patients with colorectal liver metastases undergoing hepatic resection

The prognostic significance of sarcopenia has been widely studied in different cancer patients. This study aimed to analyze the influence of sarcopenia on long-term survival in patients with colorectal liver metastasis (CRLM) undergoing hepatic resection. A retrospective analysis of 182 patients undergoing hepatic resection for CRLM was performed. Sarcopenia was determinedusing the Hounsfield unit average calculation (HUAC), a measure of muscle quality-muscledensity at preoperative abdominal computed tomography scans. Sarcopenia was defined as an HUAC score of less than 22 HU calculated using receiver operating characteristic analysis. The prognostic relevance of clinical variables and overall survival (OS) and recurrence-free survival (RFS) was evaluated. Patients with sarcopenia were older (p < 0.001) and had higher prevalence of diabetics (p = 0.004), higher body mass index (BMI) (p < 0.001) and neutrophil-to-lymphocyte ratio (p = 0.026) compared to those without. Sarcopenia was not significantly associated with OS and RFS. Multivariate Cox’s regression analysis showed that multinodularity (>3) (hazard ratio (HR) 2.736; 95% confidence interval (CI), 1.631–4.589; p < 0.001), high CEA level (≥20 ng/ml) (HR 1.793; 95% CI, 1.092–2.945; p = 0.021) and blood loss (≥300 cc) (HR1.793; 95% CI, 1.084–2.964; p = 0.023) were independent factors associated with OS. In subgroup analyses, sarcopenia was a significant factor of poor OS in the patients with multinodularity by univariate (p = 0.002) and multivariate analyses(HR 3.571; 95% CI, 1.508–8.403; p = 0.004). Multinodularity (>3) (HR 1.750; 95% CI, 1.066–2.872; p = 0.027), high aspartate aminotransferase level (HR 1.024; 95% CI, 1.003–1.046; p = 0.025) and male gender (HR 1.688; 95% CI, 1.036–2.748; p = 0.035) were independent factors of RFS. In conclusion, despite no significance in whole cohort, sarcopenia was predictive of worse OS in patients with multiple CRLM after partial hepatectomy.

The Impact of Sarcopenia on Postoperative Course following Pancreatoduodenectomy: Single-Center Experience of 110 Consecutive Cases

Background: Despite that mortality following pancreatoduodenectomy (PD) has gradually dropped during the past few decades, the incidence of postoperative complications remains high, ranging from 30–60%. Many studies have been focused on identification of perioperative risk factors for morbidity, and in recent years, sarcopenia has been pointed out as a valid predictor of postoperative complication. Materials and methods: Perioperative data from 110 consecutive patients who underwent PD were retrieved, and the presence of sarcopenia was assessed by the measurement of Hounsfield unit average calculation on preoperative CT scans. Postoperative complications were graded according to Clavien-Dindo classification, and the morbidity burden was assessed by comprehensive complication index (CCI) calculation. Results: Sarcopenia was associated with advanced age (72 vs. 66 years; p = 0.014) and lower preoperative albumin levels (3.5 vs. 3.7 g/dL; p = 0.010); it represented an independent risk factor for clinically relevant complications (relative risk: 1.71; p = 0.015) and was related to a higher rate of Grade C postoperative pancreatic fistula (50.0 vs. 11.4%; p = 0.005) and a higher CCI (47.6 vs. 29.6; p = 0.001). Conclusions: Sarcopenia represents a valid indicator of increased morbidity risk and may play a central role in preoperative risk stratification, allowing the selection of patients who may benefit from prehabilitation programs.

Sarcopenia defined by muscle quality rather than quantity predicts complications following laparoscopic right hemicolectomy.

While sarcopenia has prognostic value in elective colorectal surgery for predicting peri-operative morbidity and mortality, its role in electivelaparoscopic surgery is poorly defined. A retrospective single-center analysis of patients undergoing elective laparoscopic right hemicolectomy for adenocarcinoma between January 2010 and December 2016. Univariate analysis compared the robustness of total psoas index (TPI) with Hounsfield unit average calculation (HUAC) calculated from pre-operative CT imaging in predicting post-operative complications. Multivariate analysis compared these measures with American Society of Anesthesiologists (ASA) grade and Charlson scores in predicting post-operative complications. Of the 580 patients identified, 185 met the inclusion criteria (91 males and 94 females, with a median age of 68). UsingTPI and HUAC, 46 and 44 patients respectively were identifiedas sarcopenic, including 18 patientsthat were identified by both measures. HUAC-defined sarcopenia was significantly associated with pre-operative comorbidities, peri-operative mortality, and a greater incidence of respiratory, cardiac, and serious post-operative complications (Clavien-Dindo ≥ 3). Those with HUAC-defined sarcopenia aged > 75 were at particular risk of morbidity (OR 5.52, p = 0.002). No such relationships were found with TPI-defined sarcopenia. Only HUAC remained predictive of post-operative complications on multivariate analysis. Sarcopenia is a novel methodology for stratifying surgical risk in elective colorectal cancer surgery. HUAC has a high prognostic accuracy for the prediction of complications following laparoscopic colorectal surgery compared with TPI, ASA grade, and Charlson score.

Sarcopenia Is a Risk Factor for Infection for Patients Undergoing Abdominoperineal Resection and Flap-based Reconstruction

Background:Abdominoperineal resection (APR) carries a high risk of morbidity. Preoperative risk assessment can help with patient counseling, minimize adverse outcomes, and guide surgeons in their choice of reconstruction. This study examined the impact of sarcopenia (low lean muscle mass) on postoperative complications after APR.Methods:One hundred seventy-eight patients who underwent APR between May 2000 and July 2017 were retrospectively analyzed. Sarcopenia was identified on preoperative computed tomography scans using the Hounsfield Unit Average Calculation. Two cohorts were compared (group 1: primary perineal closure; group 2: flap-based perineal reconstruction). Multivariable analysis evaluated predictors of complications.Results:Sarcopenia was an independent risk factor for postoperative surgical site infection in patients undergoing APR (odds ratio [OR] = 2.9, P = 0.04). The risk for sarcopenic patients who underwent flap-based perineal reconstruction was even higher (OR = 8.9, P < 0.01). Male sex was also found to be a risk factor for infection (OR = 3.5, P < 0.01). Perineal flap-based reconstruction was a risk factor for delayed wound healing (OR = 3.2, P < 0.01).Conclusions:Sarcopenia was an independent risk factor for infection in patients undergoing APR. This risk was even greater in patients undergoing flap-based perineal reconstruction. Sarcopenia can be identified on preoperative imaging and inform surgeons on risk stratification and surgical plan.

Muscle Mass, Density, and Strength Are Necessary to Diagnose Sarcopenia in Patients With Gastric Cancer

BackgroundAccurate evaluation of muscle strength and function is difficult. Commonly known as sarcopenia, skeletal muscle loss is closely correlated with the prognosis of patients diagnosed with gastric cancer (GC). We wondered the correlation between skeletal muscle measures combined with computed tomography and grip strength (GS) and short-term outcomes after radical gastrectomy (RG) in patients with GC. Materials and methodsWe analyzed 594 patients with GC who underwent RG. The skeletal muscle index (SMI), skeletal muscle density (Hounsfield unit average calculation [HUAC]), and GS were measured. The skeletal muscle gauge (SMG) was created by multiplying SMI and HUAC. Logistic regression modeling and multivariate analysis were used. ResultsUnivariate analysis showed that low SMI, low HUAC, low GS, and low SMG were predictors of short-term complications after surgery. Compared with other muscle-related factors (AUCHUAC = 0.559, AUCSMI = 0.575, AUCGS = 0.580, AUCSMG = 0.598, AUCSMI+GS = 0.559), low GS plus SMG (AUCGS plus SMG = 0.614, P < 0.01) was a more accurate independent risk factor for postoperative complications. Moreover, the risk model with SMG plus GS for the diagnosis of skeletal muscle loss was superior to the other models (c-index = 0.729). ConclusionsSkeletal muscle measures using computed tomography and GS are closely correlated with short-term outcomes of patients diagnosed with GC after RG. The model contained SMG plus GS could effectively predict for patients with GC after RG at high risk of short-term outcomes. SMG plus GS has the highest accuracy for the several evaluation methods of sarcopenia.

Саркопенія як фактор прогнозування розвитку післяопераційних ускладнень у хворих з аденокарциномою підшлункової залози

Мета. Визначення впливу саркопенії на виникнення ускладнень після резекційних оперативних втручань на підшлунковій залозі (ПЗ) з приводу її злоякісних пухлин.&#x0D; Матеріали і методи. Проведено ретроспективний аналіз результатів лікування 87 пацієнтів, яким були виконані радикальні оперативні втручання. За допомогою передопераційної комп’ютерної томографії (КТ) розраховували в одиницях Хаунсфільда (од. Х.) середнє значення щільності (Hounsfield Unit Average Calculation - HUAC) та сумарний індекс (Total Psoas Index - TPI) великого поперекового м’яза на рівні ІІІ поперекового хребця.&#x0D; Результати. У 35 (40,2%) пацієнтів виявили саркопенію, застосовуючи показник HUAC. Післяопераційні ускладнення виникли у 21 (60%) хворого з саркопенією, померли 2 (5,7%) хворих. Післяопераційні ускладнення виникли у 16 (30,8%) хворих без саркопенії, помер 1 (1,9%) хворий. Застосовуючи показник TPI, саркопенію діагностували у 38 (43,7%) хворих, із них ускладнення виникли у 21 (55,3%), померли 2 (5,3%). Ускладнення виникли у 16 (32,6%) хворих без саркопенії, помер 1 (2,0%) хворий.&#x0D; Висновки. Саркопенія достовірно впливає на частоту післяопераційних ускладнень, її виявлення може бути використано для покращення відбору пацієнтів перед виконанням резекції ПЗ з приводу її злоякісних новоутворень.

Determining the impact of sarcopenia on postoperative complications after ventral hernia repair

Postoperative complication following ventral hernia repair (VHR) is a major clinical and financial burden. Preoperative risk assessment is necessary to minimize adverse outcomes following VHR. This study examines the ability of an independent parameter to predict postoperative morbidity following VHR. A retrospective analysis of 58 patients who underwent VHR by component separation between January 2009 and December 2013 was performed. Preoperative abdominal CT scans were analyzed to assess sarcopenia. Sarcopenia was determined using the Hounsfield unit average calculation (HUAC), a measure of psoas muscle size and density. Sarcopenia was defined as an HUAC score of less than 19.6HU calculated using receiver operating characteristic (ROC) analysis and the Youden index. Multivariate analysis was performed to analyze the association of sarcopenia and postoperative complications. Preoperative sarcopenia was associated with an increased risk for postoperative complications (odds ratio [OR] = 5.3; p = 0.04). Preexisting gastrointestinal conditions such as ulcerative colitis or colon cancer were associated with an increased risk for postoperative complications (OR = 5.7; p = 0.05). A significantly higher rate of hernia recurrence (33.3% vs. 10.8% [p = 0.04]) and renal failure (19% vs. 2.7% [p = 0.03]) was noted in patients with sarcopenia when compared to patients without sarcopenia. Sarcopenia is an independent risk factor for postoperative complications in patients who underwent VHR. Assessment of sarcopenia using the HUAC score provides an opportunity for the adjustment of perioperative care plans to minimize postoperative complication rates.