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Prognostic significance of preoperative osteosarcopenia on patient’ outcomes after emergency surgery for gastrointestinal perforation

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Abstract

Purpose

Sarcopenia is a prognostic predictor in emergency surgery. However, there are no reports on the relationship between osteopenia and in-hospital mortality. This study clarified the effect of preoperative osteosarcopenia on patients with gastrointestinal perforation after emergency surgery.

Methods

We included 216 patients with gastrointestinal perforations who underwent emergency surgery between January 2013 and December 2022. Osteopenia was evaluated by measuring the pixel density in the mid-vertebral core of the 11th thoracic vertebra. Sarcopenia was evaluated by measuring the area of the psoas muscle at the level of the third lumbar vertebra. Osteosarcopenia is defined as the combination of osteopenia and sarcopenia.

Results

Osteosarcomas were identified in 42 patients. Among patients with osteosarcopenia, older and female patients and those with an American Society of Anesthesiologists Physical Status of ≥ 3 were significantly more common, and the body mass index, hemoglobin value, and albumin level were significantly lower in these patients than in patients without osteosarcopenia. Furthermore, the osteosarcopenia group presented with more postoperative complications than patients without osteosarcopenia (P < 0.01). In the multivariate analysis, age ≥ 74 years old (P = 0.04) and osteosarcopenia (P = 0.04) were independent and significant predictors of in-hospital mortality.

Conclusion

Preoperative osteosarcopenia is a risk factor of in-hospital mortality in patients with gastrointestinal perforation after emergency surgery.

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Abbreviations

Alb:

Albumin

ASA:

American Society of Anesthesiologists

AUC:

Areas under the curves

BMD:

Bone mineral density

CI:

Confidence interval

Cre:

Creatinine

CT:

Computed tomography

Hb:

Hemoglobin

HU:

Hounsfield units

OR:

Odds ratio

OS:

Operative severity scores

PMA:

Psoas muscle mass area

POSSUM:

Physiological and Operative Severity Score for the en Umeration of Mortality and morbidity

PS:

Physiology scores

ROC:

Receiver operating characteristic

1,25(OH)(2)D:

25-Hydroxyvitamin D

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Authors and Affiliations

  1. Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan

    Naoko Fukushima, Takahiro Masuda, Kazuto Tsuboi, Masami Yuda, Keita Takahashi, Fumiaki Yano & Ken Eto

  2. Department of Surgery, Fuji City General Hospital, 50, Takashimatyo, Fuji-shi, Shizuoka, 417-8567, Japan

    Naoko Fukushima & Kazuto Tsuboi

Authors
  1. Naoko Fukushima
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  2. Takahiro Masuda
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  3. Kazuto Tsuboi
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  7. Ken Eto
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Correspondence to Naoko Fukushima.

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Naoko Fukushima, Takahiro Masuda, Kazuto Tsuboi, Keita Takahashi, Masami Yuda, Fumiaki Yano, and Ken Eto declare no conflicts of interest or financial ties.

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Fukushima, N., Masuda, T., Tsuboi, K. et al. Prognostic significance of preoperative osteosarcopenia on patient’ outcomes after emergency surgery for gastrointestinal perforation. Surg Today (2024). https://doi.org/10.1007/s00595-024-02849-3

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