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“Sarcopenia is associated with increased risk of burst abdomen after emergency midline laparotomy: a matched case–control study”

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Abstract

Purpose

Burst abdomen is a serious complication commonly observed after emergency midline laparotomy. Sarcopenia has been associated with increased morbidity and mortality after abdominal surgery. This single-center, retrospective, matched case–control study aimed to investigate the association between sarcopenia and burst abdomen in patients undergoing emergency midline laparotomy.

Methods

Patients who had burst abdomen after emergency midline laparotomy were matched 1:4 with controls based on age and sex. Abdominal wall closure was standardized in the study period with the small bites, small stitches technique. CT assessed psoas cross-sectional area was used as a surrogate measure of sarcopenia. Sarcopenia was defined as the sex-specific lowest quartile of psoas cross-sectional area adjusted for body surface area. The primary outcome was the incidence rate of sarcopenia amongst cases and controls. Secondary outcomes were risk factors for burst abdomen and death that were identified using multivariate logistic regression analysis.

Results

67 cases were matched to 268 controls during May 2016–December 2019. BMI > 30 kg/m2, liver cirrhosis, smoking, high ASA score and peritonitis were more frequently observed among cases. Multivariate analysis revealed that sarcopenia (odds ratio (OR) 2.3, p = 0.01), active smoking (OR 2.3, p = 0.006) and liver cirrhosis (OR 3.7, p = 0.042) were significantly associated with burst abdomen. ASA score ≥ 3 (OR 5.5, p = 0.001) and ongoing malignant disease (OR 3.2, p = 0.001) were significantly associated with increased 90-day mortality.

Conclusion

Sarcopenia is associated with increased risk of burst abdomen after midline laparotomy. Prospective trials are needed.

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Acknowledgements

Shruti Gaggar, Center for Surgical Science, Zealand University Hospital, assisted in the proofreading and final setup of this manuscript.

Funding

No funding was received for conducting this study.

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Authors and Affiliations

  1. Surgical Section, Department of Gastrointestinal- and Hepatic Diseases, Copenhagen University Hospital Herlev, 2730, Herlev, Denmark

    Thomas Korgaard Jensen

  2. Department of Radiology, Copenhagen University Hospital Herlev, 2730, Herlev, Denmark

    Yousef Wirenfeldt Nielsen

  3. Department of Surgery, Center for Surgical Science, Zealand University Hospital, Copenhagen University Hospital, 4600, Koege, Denmark

    Ismail Gögenur

  4. Department of Surgery, North-Zealand University Hospital, 3400, Hilleroed, Denmark

    Mai-Britt Tolstrup

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  1. Thomas Korgaard Jensen
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  2. Yousef Wirenfeldt Nielsen
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Correspondence to Thomas Korgaard Jensen.

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The authors state no financial or non-financial conflicts of interests for this study.

Ethical approval

This study was evaluated by the National committee on Health Research Ethics and assessed of no need for approval (H-20034185).

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This study was approved by the Danish Data Protection Agency (HGH-2016-030) and the Danish Patient Safety Authority (31-1521-382).

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Jensen, T.K., Nielsen, Y.W., Gögenur, I. et al. “Sarcopenia is associated with increased risk of burst abdomen after emergency midline laparotomy: a matched case–control study”. Eur J Trauma Emerg Surg 48, 4189–4196 (2022). https://doi.org/10.1007/s00068-022-01958-3

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  • DOI: https://doi.org/10.1007/s00068-022-01958-3

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