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Effect of sarcopenia on clinical and surgical outcome in elderly patients with proximal femur fractures

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Abstract

Purpose

To investigate the relationship between sarcopenia with short-term surgical outcome in elderly patients with proximal femur fractures.

Methods and materials

Following Institutional Review Board approval, a database of patients receiving a pelvis CT scan for acute trauma between January 2000–August 2016 was screened for an isolated proximal femur fracture. Patients were excluded if they were: < 50 years old, had conditions predisposing to sarcopenia (renal failure, congestive heart failure, muscular dystrophies), had undergone no surgical treatment, had other major traumatic injuries, or had a pathologic femur fracture. The paraspinal muscle density (PSD) at the L4 level was measured in Hounsfield units. The skeletal muscle index (SMI) was measured as the total skeletal muscle area at L4 divided by patient height.2 PSD and SMI were tested for association with surgical outcome measures: length of hospital stay, perioperative mortality, medical complications, in-hospital blood transfusion volume, and 90-day readmission rate, using multiple variable regression analysis. Pearson correlation of PSD and SMI was performed.

Results

Controlling for age, gender, body mass index (BMI), and fracture type, low PSD and SMI were both independently associated with longer length of hospitalization (p = 0.008 and p = 0.032, respectively). Low PSD was associated with a higher amount of blood transfusion volume during the perioperative period (p = 0.004). Pearson correlation revealed moderate positive correlation between the SMI and PSD (r = 0.579, p < 0.001).

Conclusion

In proximal femur fractures, elderly patients with sarcopenia are more likely to have prolonged hospitalization following surgery and require more blood transfusion volume during the perioperative period.

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Author information

Authors and Affiliations

  1. Department of Radiology, Kaohsiumg Chang, Chang Gung University College of Medicine, Kaohsiung city, Taiwan

    Ching-Di Chang

  2. Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA

    Ching-Di Chang, Jim S. Wu, Jennifer Ni Mhuircheartaigh, Marry G. Hochman & Colm J. Mcmahon

  3. Department of Orthopedics, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA

    Edward K. Rodriguez & Paul T. Appleton

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  1. Ching-Di Chang
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Correspondence to Jim S. Wu.

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Beth Israel Deaconess Medical Center Institutional Review Board approved.

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Chang, CD., Wu, J.S., Mhuircheartaigh, J.N. et al. Effect of sarcopenia on clinical and surgical outcome in elderly patients with proximal femur fractures. Skeletal Radiol 47, 771–777 (2018). https://doi.org/10.1007/s00256-017-2848-6

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  • DOI: https://doi.org/10.1007/s00256-017-2848-6

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