Lean Patient Research Articles

Improving the Waiting Time in Outpatient Clinics Using Lean Approach in Hospital: A Systematic Review

Introduction: The use of the lean approach in healthcare has rapidly gained popularity globally, although this approach was more routinely used in the manufacturing sector as opposed to health. Besides, recent studies confirm the suitability of the lean approach applications for improving the quality of medical care. This study aimed to determine the Lean approach’s capacity to improve the waiting time in outpatient clinics in hospitals. Methods: The systematic review approach was employed to help in the research procedures. Search databases used included Ovid, Google scholar, PubMed, MEDLINE, and archive. Besides, search terminologies such as the Lean approach, Hospital-implementation, waiting time, and patient flow were used to help identify sources that best suited the investigation process. Results: The review revealed that the lean approach is suitable for the reduction of waiting times as well as for improving efficiency in the clinic. The outcomes provide a basis for reducing the average waiting time within the hospital. Conclusion: This study recommended that healthcare facilities and departments should take a keen interest in implementing the Lean approaches, as they are crucial for reducing waiting time.

Severe Obesity Associated With Pituitary Corticotroph Hyperplasia and Neoplasia

ObjectiveTo investigate the incidence of corticotroph hyperplasia (CH) or lymphocyte infiltration in the pituitary of patients with obesity. MethodsThe pituitary and adrenal glands from 161 adult autopsies performed between 2010 and 2019 at our institution were reviewed. The clinical history, body mass index (BMI), and cause of death were recorded. Routine hematoxylin and eosin staining, reticulin staining, and immunohistochemical staining for adrenocorticotropic hormone, CD3, and CD20 were performed. The results were analyzed using the Fisher and chi-square statistics. Decedents were separated into 4 groups based on BMI (kg/m2): (1) lean (BMI, <25.0), (2) overweight (BMI, 25.0-29.9), (3) obesity class I (BMI, 30.0-34.9), and (4) obesity classes II to III (BMI, >34.9). ResultsCH/neoplasia was identified in 44 of 161 pituitary glands. Four (9.1%) of 53 lean patients had pituitary lesions, whereas 27.3% (12) of overweight, 22.7% (10) of obesity class I, and 40.9% (18) of obesity class II patients had hyperplasia (P < .0001). Small corticotroph tumors were identified in 15 patients; only 1 was a lean patient, and the tumor was associated with the Crooke hyaline change of nontumorous corticotrophs. The presence of CH and neoplasia was associated with adrenal cortical hyperplasia and lipid depletion. Microscopic foci of T and B lymphocytes were identified in the pituitaries of patients in each weight category; no independent association between BMI and lymphocyte inflammation was found. ConclusionOur data indicate an association between CH/neoplasia and obesity. It remains unclear whether obesity is the cause or effect of adrenocorticotropic hormone and cortisol excess.

Risk Factor Evaluation of Non Alcoholic Fatty Liver Disease in Lean Individual

Background : Non-Alcoholic Fatty Liver Disease (NAFLD) is epidemic around the world. Bangladesh is also experiencing an increasing trend of NAFLD. Obesity is a common clinical phenotype associated with NAFLD, which is linked to metabolic syndrome and related comorbidities, including type II diabetes, hypertension and dyslipidemia. Clearly, not all obese subjects develop NAFLD and NAFLD also can be found in non-obese patients. This subset of individuals, known to have ‘lean NAFLD’ or ‘non-obese NAFLD’, is growing increasingly prevalent. NAFLD in lean patients appears to be more common among Asians. So it is important to look for risk factors for NAFLD in lean patients for prevention of advanced liver disease. The objective of our study was to find out the risk factors of NAFLD in lean (Nonobese) individual.&#x0D; Materials and methods: It was prospective observational study done on 100 patients attending in the Gastroenterology Department and OPD of Chittagong Medical College Hospital after approval of Ethical and Review Committee of CMC and grant from DGHS. Total 100 patients having 18 to 65 years of age, were taken as study subjects who met inclusion criteria. Informed written consent was obtained from the patients or attendant after full explanation of the purpose of the study. Fasting Blood Glucose (FBS) Fasting lipid profile, SGPT, SGOT, Ultrasonography of hepatobiliary system and Fibrosan were done. All necessary data was included in the data collection sheet and was analyzed by Microsoft excel and SPSS-23.&#x0D; Results: 100 patients were included in this study. Mean age of this study with age was in between 18 years to 65 years.Male to female ratio was 3:1 in the studied population.The majority of the lean patient with NAFLD (31%) was in the age group 40-49 years. The majority of the lean patient with NAFLD (83%) was in normal BMI range 18.5-22.99 kg/m2 and 13% had BMI &lt;18.50 kg/m. Out of 100patients diabetes and hypertension were found 22% and 17% of patients respectively. 22% and 17% patients. 65% and 37% patients had raised SGPT and SGOT respectively. Out of 100 subjects, 50% had raised triglyceride level (50%) and 18% had raised LDL cholesterol (18%) level.According to Ultrasonography findings 68% were in Grade I, 11% in Grade II and only 1 patient was in Grade III fatty liver. Fibroscan of 100 subjects, Significant fibrosis ( ³2 F) was observed in 9%, while advanced fibrosis (F4) was seen in 4% of patients. As per steatosis score 36% was in S2 and 34% were in S3 grade. Median fibrosis score and steatosis score was significantly higher in patients with high SGPT compared to patients with normal SGPT (p &lt;0.005) whereas median fibrosis score and steatosis score was higher in patients with high SGOT compared to patients with normal SGOT, but only the difference in steatosis score reached statistical significance (p&lt;.042). AUC of SGPT for discriminating fibrosis grade F0-F1 from Grade F2-F4 was 0.565 (95% CI: 0.404-0.726, p=0.519). AUC of SGOT for discriminating fibrosis grade F0-F1 from Grade F2-F4 was 0.573 (95% CI: 0.342-0.803, p=0.474). This indicated that there was no significant role of SGPT or SGOT values for prediction of significant fibrosis ( ³2F).AUC of SGPT for discriminating steatosis grade S0-S2 from Grade S3-S4 was 0.565 (95% CI: 0.404-0.726; p=0.519). AUC of SGOT for discriminating steatosis grade S0-S2 from Grade S3-S4 was 0.573 (95% CI: 0.342-0.803, p=0.474). This indicated that both SGPT and SGOT had significant role for prediction of significant steatosis ( ³3S).Higher age (p &lt;0.028) and female sex (p&lt;0.013) were revealed as independent predictive factors for significant fibrosis ( ³F2) in non-obese NAFLD patients on performing multivariate binary logistic regression.&#x0D; Conclusion Lean NAFLD is now frequently recognized in day-to-day clinical practice, however, the data on epidemiology, risk factors, physiopathology, distinctive histologic changes, natural history and treatment of this entity are still scanty. From a biological point of view, lean NAFLD be haves much like obese NAFLD. Our study may help to find out risk factors in nonobese NAFLD which may help prevention of advance liver disease by early intervention.&#x0D; JCMCTA 2022 ; 33 (1) : 56-65

General Purpose Pharmacokinetic-Pharmacodynamic Models for Target-Controlled Infusion of Anaesthetic Drugs: A Narrative Review.

Target controlled infusion (TCI) is a clinically-available and widely-used computer-controlled method of drug administration, adjusting the drug titration towards user selected plasma- or effect-site concentrations, calculated according to pharmacokinetic-pharmacodynamic (PKPD) models. Although this technology is clinically available for several anaesthetic drugs, the contemporary commercialised PKPD models suffer from multiple limitations. First, PKPD models for anaesthetic drugs are developed using deliberately selected patient populations, often excluding the more challenging populations, such as children, obese or elderly patients, of whom the body composition or elimination mechanisms may be structurally different compared to the lean adult patient population. Separate PKPD models have been developed for some of these subcategories, but the availability of multiple PKPD models for a single drug increases the risk for invalid model selection by the user. Second, some models are restricted to the prediction of plasma-concentration without enabling effect-site controlled TCI or they identify the effect-site equilibration rate constant using methods other than PKPD modelling. Advances in computing and the emergence of globally collected databases has allowed the development of new “general purpose” PKPD models. These take on the challenging task of identifying the relationships between patient covariates (age, weight, sex, etc) and the volumes and clearances of multi-compartmental pharmacokinetic models applicable across broad populations from neonates to the elderly, from the underweight to the obese. These models address the issues of allometric scaling of body weight and size, body composition, sex differences, changes with advanced age, and for young children, changes with maturation and growth. General purpose models for propofol, remifentanil and dexmedetomidine have appeared and these greatly reduce the risk of invalid model selection. In this narrative review, we discuss the development, characteristics and validation of several described general purpose PKPD models for anaesthetic drugs.

Development of Sustainable Lean Patient Value in Healthcare: A Long-Term Condition Context

The purpose of this paper is to examine the role of sustainable Lean patient value in relation to a long-term health condition in a healthcare context. A pragmatist research philosophy is used to conduct exploratory research utilising open data sources, semi-structured interviews, focus group meetings and participant workshops, where the quantitative data covered a 60-month period and the qualitative data collection and analysis covered a 36-month period. The findings show that Lean healthcare is overly focused on healthcare providers rather than patients leading to unmet value across the patient Value Stream. To conceptualise the findings and present the constructs and their relationships, a Lean patient healthcare framework is inductively developed. A number of propositions are advanced based on the relationships in the framework which provide a basis for further exploring improved Lean healthcare interventions in long-term conditions. The findings will assist healthcare academics, professionals and patient groupings in developing and improving Lean patient Value understanding and decision making. This will assist in effective Lean patient value creation and development for healthcare reforms and changes and in effective resource utilisation for improved and sustainable patient outcomes.

Severe hyperinsulinemia and osteoporosis in a lean patient with Jacobsen syndrome

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

APPLICATION OF LEAN SIX SIGMA TO REDUCE PATIENT WAITING TIME: LITERATURE REVIEW

APPLICATION OF LEAN SIX SIGMA TO REDUCE PATIENT WAITING TIME: LITERATURE REVIEW

Eruptive xanthomas, lipemia retinalis in a lean young female patient with new onset diabetes mellitus and hypertriglyceredemia

Eruptive xanthomas and lipemia Retinalis are a very rare finding which is pathognomonic of underlying Hypertriglyceridemia and Diabetes mellitus. Both these clinical entities are an indication of underlying metabolic derangements, so prompt action in the form of life style modification and drug therapy is important to avoid the development of serious long term complications like atherosclerosis and pancreatitis. We present a rare case of Eruptive xanthomas and lipemia Retinalis in 16years old young lean female patient as the first presentation of new onset Diabetes mellitus and underlying hypertriglyceridemia.

English

BACKGROUND Mini-cholecystectomy (MC), with its varied incision length, has long been considered feasible with comparable results to laparoscopic cholecystectomy (LC) 1-6,7 We undertook this study, driven by resource-constraints, by well-experienced surgeons, using 3 - 5 cm incision length, in our patients with low BMI. The aim of this study is to compare the results and outcomes between MC and LC. METHODS In this retrospective study of a prospectively maintained database, first 50 patients each were selected for MC and LC respectively. Operative time, pain-score, SSI (Surgical Site Infection), hospital stay, return to normal activity and complications were compared. RESULTS Both groups were matched for age, sex, BMI (Body Mass Index) and American Society of Anesthesiologists (ASA) grading. The mean operating time for MC was 43 minutes and for LC, 64 minutes. Hospital stay for MC was 1.9 days and for LC was 1.8 days, which was statistically not significant. Return to normal activity was 8 days for MC and 6.6 days for LC. In a subset analysis of eight lean and thin patients using 3 - 3.5 cm length incision with rectus muscle splitting, the return to normal activity was 6.9 days which is comparable to LC patients. CONCLUSIONS Mini-cholecystectomy and laparoscopic cholecystectomy produce comparable patient outcomes. In lean and thin patient, MC may be slightly more advantageous than LC in terms of less operating time. KEYWORDS Mini-Cholecystectomy, Laparoscopic Cholecystectomy, Outcome, Lean and Thin Patient

Lean Healthcare Practices Improve the Patient Performance in Public Hospitals

Healthcare industry is one of the industry that particular importance for development in Malaysia economy. Nowadays, this industry trying to implement the resources more effectively and efficiently. The rapidly growth in healthcare showed that the demanding in providing the services become more challenging. Lean healthcare practices is one of the principles that can minimize the waste in every procedure and can develop the task through to healthcare system. Therefore, this study explored to review the lean healthcare practices and patient performance in public hospitals. In this study, a structured model has been proposed by Structural Equation Modeling (SEM – PLS). In addition, the research hypotheses are being developed in this study.

The Pathophysiology of Type 2 Diabetes Mellitus in Non-obese Individuals: An Overview of the Current Understanding.

The pandemic of type 2 diabetes mellitus (T2DM) has been largely attributed to the increasing prevalence of worldwide obesity at a geometric rate. However, the number of non-obese patients with T2DM is also on the rise, and it is as high as 60-80% in some Asian countries. These non-obese individuals have certain peculiarities and have a higher mortality rate compared with obese individuals. The pathophysiology of T2DM in non-obese individuals remains poorly understood, and this has an impact on defining its management. This review discusses the current understanding of the pathophysiology of T2DM in non-obese individuals. The definition of T2DM in non-obese individuals remains controversial because of the limited clinical measurements, and the current definition of obesity using body mass index (BMI) is not very helpful as these individuals have BMIs of <25K g/m3, which is considered normal. Many authors have argued that the so-called non-obese people are actually metabolically obese; however, in terms of the measurements clinically available, they are non-obese. The simplistic understanding of the mechanism of the pathophysiology sees it in terms of the balance between insulin secretion and insulin resistance. The pathogenesis of insulin resistance in a lean patient has been proven to be the same as what is seen in an obese individual, but most studies confirm more severe functional insulin secretory defects in lean individuals compared to the obese phenotype. The mechanism underlying this form of T2DM is still poorly defined, and more research is required to understand the mechanism of sarcopenic obesity, which some studies have revealed.

Lean Management and U.S. Public Hospital Performance: Results From a National Survey.

Many public hospitals have adopted Lean management methodology, but little is known about the extent of Lean adoption or the relationship between Lean adoption and hospital performance. Using data from the 2017 National Survey of Lean/Transformational Performance Improvement in Hospitals, linked with data from the American Hospital Association 2015 Annual Hospital Survey and 2015 Centers for Medicare & Medicaid Services data on hospital performance, we compare public hospitals with nonprofit and for-profit hospitals on the rate of Lean adoption and the extent of Lean implementation. We also assess the associations between Lean adoption by the end of 2014 and measures of public hospital financial performance, patient outcomes, and patient satisfaction measured in 2015.Among the 288 public hospitals that responded to the survey, 54.2% reported that they had adopted Lean. The average length of time of Lean implementation was 4.58 years. The mean number of units in which Lean was implemented was 11.9 out of 29 possible hospital units, with the emergency department (ED) being the unit in which Lean was most frequently implemented. The most common Lean practices used were daily huddles, plan-do-study-act cycles, visual management, and use of standard work. Lean adoption by 2014 was significantly associated in the direction predicted with earnings before interest, taxes, depreciation, and amortization margin (b = .042, p < .020) and percentage of patients leaving the ED without being seen (b = -0.610, p < .068). No significant associations were found between Lean adoption and patient outcomes or patient satisfaction.

The Contribution of New Technologies to Lean and Safe Patient Care

When introducing new knowledge to healthcare organizations, in addition to professional and medical expertise, other knowhow is also included, typically from the field of safe and high-quality patient care, work organization, optimization of work processes, and the use of various technologies to record completed work processes. As well as relying on professional staff and their knowledge or competences, high-quality and safe patient care, which is primarily part of the process of treatment and nursing, is also largely dependent on the organization of the health institution at all levels. It is especially important how work processes, workflow and standardization are connected, how unnecessary work, errors and waiting are prevented, and how poor relationships in work groups and/or between different groups are eliminated.

Effect of Weight Reduction on Histological Activity and Fibrosis of Lean Nonalcoholic Steatohepatitis Patient.

Background and ObjectivesWeight reduction has evidenced benefit on attenuation of histological activity and fibrosis of nonalcoholic steatohepatitis (NASH), but there is scarcity of data for lean NASH subgroup. We have designed this study to compare the effects of weight reduction on histological activity and fibrosis of lean and non-lean NASH.MethodsWe have included 20 lean and 20 non-lean histologically proven NASH patients. BMI < 25 kg/m2 was defined as non-lean. Informed consent was taken from each subject. All methods were carried out in accordance with the Declaration of Helsinki. Moderate exercise along with dietary restriction was advised for both groups for weight reduction. After 1 year, 16 non-lean and 15 lean had completed second liver biopsy.ResultsAge, sex, alanine transaminase (ALT), aspartate aminotransferase (AST), gamma-glutamyltrasferase (GGT), Homeostasis model assessment insulin resistance (HOMA-IR), triglyceride and high density lipoprotein (HDL) was similar in both groups. Steatosis, ballooning, lobular inflammation, nonalcoholic fatty liver disease activity score (NAS) and fibrosis was similar in the two groups. In lean/non-lean group, any amount of weight reduction, ≥ 5% weight reduction and ≥ 7% weight reduction was found in respectively 8/11, 5/6 and 2/6 patients. In both lean and non-lean groups, weight reduction of any amount was associated with significant reduction of steatosis, ballooning and NAS, except lobular inflammation and fibrosis. In both groups, weight reduction of ≥ 5% was associated with significant reduction in NAS only. However, significant improvement in NAS was noted with ≥ 7% weight reduction in non-lean group only.ConclusionSmaller amount of weight reduction had the good benefit of improvement in all the segments of histological activity in both lean and non-lean NASH.

Examining Governance in Hospital Operations: The Effects of Trust and Physician Employment in Achieving Efficiency and Patient Satisfaction

ABSTRACTGovernance can be challenging in healthcare operations, particularity when attending physicians lack financial relationships with the hospital. In the absence of formal incentive system mechanisms, it may be possible to use informal relational governance to synchronize activities. We use Relational Resource Based View and Agency theory to conceptualize trust (an informal governance mechanism) and physician employment (a formal governance mechanism) as moderators of key operational phenomena in hospitals. Specifically, we test the moderated effects of trust and physician employment on the relationships among lean strategy, process integration, operational efficiency, and patient satisfaction. Analysis of 583 data points from 302 acute care U.S. hospitals reveals that lean strategy impacts process integration, and process integration impacts operational efficiency and patient satisfaction. Trust enhances the positive relationship between lean strategy and process integration such that the relationship is stronger when physicians are employed by the hospital and weaker when physicians are not employed by the hospital. A post hoc analysis reveals that physician employment also influences how process integration affects patient satisfaction. Our results explain the key roles of trust, physician employment, and integration in linking strategy and outcomes. Practitioner interviews validate and help to tease out the implications of our findings. This study contributes important insights for researchers, executives, and policy makers interested in governance and improvements in healthcare delivery.

Successful Treatment of Immune Checkpoint Inhibitor–Induced Diabetes With Infliximab

We report a case of a 53-year-old male patient with melanoma who was treated with combination immune checkpoint blockade (ICB) with ipilimumab and nivolumab. The patient had advanced disease with metastasis to the liver, lung, and lymph nodes. After two doses of ICB, the patient developed hypocalcemia as a result of an immune-mediated hypoparathyroidism that was treated with calcium and vitamin D substitution. In addition, the patient suffered from immune-related colitis that required treatment with corticosteroids and two doses of infliximab. Combination immunotherapy led to a metabolic complete remission of the melanoma. After tapering corticosteroids, the patient was continued on nivolumab for several weeks. No abnormalities of blood glucose were noted until then in an otherwise lean patient with a BMI of 19.6 kg/m2. When the patient developed a seronegative oligoarthritis affecting the right knee and both ankles, he was treated with …

Clinical utility of genomic analysis in adults with idiopathic liver disease

Adult patients suffering from liver disease of unknown cause represent an understudied and underserved population. The use of whole-exome sequencing (WES) for the assessment of a broader spectrum of non-oncological diseases, among adults, remains poorly studied. We assessed the utility of WES in the diagnosis and management of adults with unexplained liver disease despite comprehensive evaluation by a hepatologist and with no history of alcohol overuse. We performed WES and deep phenotyping of 19 unrelated adult patients with idiopathic liver disease recruited at a tertiary academic health care center in the US. Analysis of the exome in 19 cases identified 4 monogenic disorders in 5 unrelated adults. Patient 1 suffered for 18 years from devastating complications of undiagnosed type 3 familial partial lipodystrophy due to a deleterious heterozygous variant in PPARG. Molecular diagnosis enabled initiation of leptin replacement therapy with subsequent normalization of liver aminotransferases, amelioration of dyslipidemia, and decreases in daily insulin requirements. Patients 2 and 3 were diagnosed with MDR3 deficiency due to recessive mutations in ABCB4. Patient 4 with a prior diagnosis of non-alcoholic steatohepatitis was found to harbor a mitochondrial disorder due to a homozygous pathogenic variant in NDUFB3; this finding enabled initiation of disease preventive measures including supplementation with antioxidants. Patient 5 is a lean patient with hepatic steatosis of unknown etiology who was found to have a damaging heterozygous variant in APOB. Genomic analysis yielded an actionable diagnosis in a substantial number (∼25%) of selected adult patients with chronic liver disease of unknown etiology. This study supports the use of WES in the evaluation and management of adults with idiopathic liver disease in clinical practice. We performed whole-exome sequencing in 19 adult patients with unexplained liver disease after an unrevealing conventional work-up performed by a hepatologist. In 5 cases, genomic analysis led to a diagnosis and informed treatment and management of the disease. Therefore, we suggest using whole-exome sequencing in the evaluation and management of adults with unexplained liver disease.

An integrated lean methodology for improving patient flow in an emergency department – case study of a Saudi Arabian hospital

This study presents an integrated lean methodology for improving patient flow by identifying root causes of patient flow problems and proposing a lean patient flow process in emergency departments (EDs). The methodology combines the ‘voice of process’, the ‘voice of customers’ and the ‘voice of staff’ to identify non-value-added activities in the ED process. This integration was used to model, evaluate and improve work and process flow in the hospital’s ED. The current activities were analysed using process mapping and the A3 problem-solving sheet as visual tools to identify sources of waste. Aseer Central Hospital in Saudi Arabia was selected as the organisational case for this research. The study identified several critical areas of waste that significantly affect patient flow in the ED. The investigation reveals that these wastes were mainly related to the quality management, ED facilities, patients, physicians, nurses, administration, data/information and uncertainty/changes to work schedules in treatment. Based on the identified wastes, recommendations are made to design a lean process flow by eliminating root causes of overcrowding and waste in EDs. The proposed process model links key areas associated with the root causes of patient flow problem and highlighting critical areas that need improvement.

Association of Optimal Combination Drug Treatment with Obesity Status among Recent Ischemic Stroke Patients: Results of the Vitamin Intervention for Stroke Prevention (VISP) Trial.

Background and PurposeOne explanation for the ‘obesity paradox’, where obese patients seem to have better cardiovascular outcomes than lean patients, is that obese patients display an identifiable high cardiovascular risk phenotype that may lead to receiving or seeking earlier/more aggressive treatment. MethodsWe analyzed a clinical trial dataset comprising 3643 recent (<120 days) ischemic stroke patients followed up for 2 years. Subjects were categorized as lean (body mass index [BMI], <25 kg/m2, n=1,006), overweight (25-29.9 kg/m2, n=1,493), or obese (≥30 kg/m2, n=1,144). Subjects were classified as level 0 to III depending on the number of secondary prevention prescriptions divided by the number of potentially indicated drugs (0=none of the indicated medications and III=all indicated medications as optimal combination drug treatment [OCT]). Independent associations between each BMI category and stroke/myocardial infarction/vascular death (major vascular events [MVEs]) and all-cause death were assessed. ResultsMVEs occurred in 17.4% of lean, 16.1% of overweight, and 17.1% of obese patients; death occurred in 7.3%, 5.5%, and 5.1%, respectively. Individuals with a higher BMI status received more OCT (45.8%, 51.7%, and 55.3%, respectively; P<0.001). In the lean patient group, multivariable adjusted Cox analyses, showed that compared with levels 0-I, level II and level III were linked to lower risk of MVEs (hazard ratio [HR] 0.55; 95% confidence interval [CI]: 0.32–0.95 and HR 0.48; 95% CI: 0.28−0.83, respectively) and death (0.44; 0.21–0.96 and 0.23; 0.10−0.54, respectively). ConclusionsOCT for secondary prevention after an ischemic stroke is less frequent in lean (vs. obese) subjects, but when implemented is related to significantly better clinical outcomes.

Effect of low appendicular lean mass, grip strength, and gait speed on the functional outcome after surgery for distal radius fractures.

Loss of skeletal muscle mass and consequent loss in muscle function associate with aging, and this condition negatively impacts the activities of daily living and increases elderly individuals' frailty to falls. Thus, patients with low appendicular lean mass would show different functional recovery compared to those without this condition after surgery for distal radius fracture (DRF). This study compares the functional outcomes after surgery for DRF in patients with or without low appendicular lean mass plus slowness or weakness. A total of 157 patients older than 50years of age with a DRF treated via volar plate fixation were enrolled in this prospective study. A definition of low appendicular lean mass with slowness or weakness was based on the consensus of the Asian Working Group for Sarcopenia. The researchers compared functional assessments (wrist range of motion and Michigan Hand Questionnaire [MHQ]) and radiographic assessments (radial inclination, volar tilt, ulnar variance, and articular congruity) 12months after surgery between patients with and without low appendicular lean mass plus slowness or weakness. Multivariable regression analyses were performed to determine whether appendicular lean mass, grip strength, gait speed, patient demographic, or injury characteristics accounted for the functional outcomes. Patients with low appendicular lean mass plus slowness or weakness showed a significantly lower recovery of MHQ score than those in the control group throughout 12months. There was no significant difference in the range of motion between the groups. The radiologic outcomes showed no significant difference between groups in terms of volar tilt, radial inclination, or ulnar variance. According to multivariable regression analysis, the poor recovery of MHQ score was associated with an increase in age, weak grip strength, and lower appendicular lean mass, and these three factors accounted for 37% of the variation in the MHQ scores. Patients with low appendicular lean mass plus slowness or weakness are at risk for poor functional recovery after surgery for DRF, even when they have similar radiologic outcomes.