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Radiographic Sarcopenia and Self-reported Exhaustion Independently Predict NSQIP Serious Complications After Pancreaticoduodenectomy in Older Adults

  • Pancreatic Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Introduction

Sarcopenia is linked to poor outcomes after abdominal surgery. We hypothesized that radiographic sarcopenia metrics enhance prediction of complications after pancreaticoduodenectomy (PD) when combined with clinical and frailty data.

Methods

Preoperative geriatric assessments and CT scans of patients undergoing PD were reviewed. Sarcopenia was assessed at L3 using total psoas area index (TPAI) and weighted average Hounsfield units (HU), i.e., estimates of psoas muscle volume and density. Outcomes included 30-day American College of Surgeons National Surgical Quality Improvement Program (NSQIP) serious complications, Clavien–Dindo complications, unplanned intensive care unit (ICU) admission, hospital length of stay (LOS), non-home facility (NHF) discharge, and readmission rates.

Results

Low HU score correlated with NSQIP serious complications (r = −0.31, p = 0.0098), Clavien–Dindo complication grade (r = −0.29, p = 0.0183), unplanned ICU admission (r = −0.28, p = 0.0239), and NHF discharge (r = −0.25, p = 0.0426). Controlling for a “base model” of age, body mass index, American Society of Anesthesiologists score, and comorbidity burden, Fried’s exhaustion (odds ratio [OR] 4.72 [1.23–17.71], p = 0.021), and HU (OR 0.88 [0.79–0.98], p = 0.024) predicted NSQIP serious complications. Area under the receiver-operator characteristic (AUC) curves demonstrated that the combination of the base model, exhaustion, and HU trended towards improving the prediction of NSQIP serious complications compared with the base model alone (AUC = 0.81 vs. 0.70; p = 0.09). Additionally, when controlling for the base model, TPAI (β-coefficient = 0.55 [0.10–1.01], p = 0.018) and exhaustion (β-coefficient = 2.47 [0.75–4.20], p = 0.005) predicted LOS and exhaustion (OR 4.14 [1.48–11.6], p = 0.007) predicted readmissions.

Conclusions

When combined with clinical and frailty assessments, radiographic sarcopenia metrics enhance prediction of post-PD outcomes.

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Acknowledgment

The authors gratefully acknowledge Mitchell C. Posner, M.D., Jeffrey B. Matthews, M.D., Eugene A. Choi, M.D., and Alaine Kamm, N.P., who recruited and cared for study patients and collected data; Aparna Palakodeti, Ph.D., who participated in study design and CT analysis; Teresa G. Barry and Randi Rothman, who performed GA and collected data; and Nneka Chukwueke, who collected data. Finally, we dedicate this work to the memory of our beloved friend and colleague, Joshua A. Hemmerich, Ph.D.

Disclosure

This study was funded by Carole and Gordon Segal, the Michael Rolfe Pancreatic Cancer Foundation, and the Ben D. Kissel Fund for Pancreatic Cancer Research. The authors maintained full independence in the conduct of this research and have no commercial interests in the subject of this study.

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    Authors and Affiliations

    1. Department of Surgery, The University of Chicago, Chicago, IL, USA

      Malini D. Sur MD, Jukes P. Namm MD & Kevin K. Roggin MD

    2. Section of Geriatrics & Palliative Medicine, Department of Medicine, The University of Chicago, Chicago, IL, USA

      Joshua A. Hemmerich PhD, Mary M. Buschmann PhD & William Dale MD, PhD

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    1. Malini D. Sur MD
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    3. Joshua A. Hemmerich PhD
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    Correspondence to William Dale MD, PhD.

    Additional information

    Joshua A. Hemmerich was Deceased on March 25, 2015.

    Kevin K. Roggin and William Dale have contributed equally to this work.

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    Sur, M.D., Namm, J.P., Hemmerich, J.A. et al. Radiographic Sarcopenia and Self-reported Exhaustion Independently Predict NSQIP Serious Complications After Pancreaticoduodenectomy in Older Adults. Ann Surg Oncol 22, 3897–3904 (2015). https://doi.org/10.1245/s10434-015-4763-1

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