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Perioperative loss of the psoas major muscle area index in elderly patients with hip fracture: spinal anesthesia versus general anesthesia—a retrospective cohort study

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Abstract

Purpose

In hip fracture patients aged ≥ 80 years, we investigated whether the perioperative reduction in the psoas major muscle index (PMI) for spinal anesthesia was less than that for general anesthesia.

Methods

A total of 262 patients surgically treated for intertrochanteric or femoral neck fractures between August 2015 and August 2022 were enrolled. After adjusting for propensity score matching, 50 patients were included in this analysis. After matching, patients were divided into those receiving spinal or general anesthesia.

We measured the psoas major muscle area (PMA) by adjusting for the patient’s height as PMA (cm2) divided by height (m) squared. The adjusted PMA was defined as the PMI. We calculated the variability in PMI (ΔPMI) before and after surgery. The primary outcome was the proportion of patients with a > 10% reduction in ΔPMI. The secondary outcomes were the mean ΔPMI and estimated factors affecting the postoperative reduction in the PMI. We compared the primary and secondary outcomes between spinal and general anesthesia.

Results

The proportion with a > 10% reduction in ΔPMI did not differ between spinal and general anesthesia (36.0% vs. 40.0%, odds ratio:1.19, 95% CI:0.38–3.72, p = 0.31). The ΔPMI did not differ between spinal and general anesthesia (− 8.7% ± 7.9% vs. − 8.9% ± 8.3%, p = 0.93). The factors affecting the postoperative reduction in the PMI were male sex, preoperative non-sarcopenia, and intramedullary nailing.

Conclusion

There was no significant difference in ΔPMI between hip fracture patients ≥ 80 years of age receiving spinal versus general anesthesia undergoing surgical treatment.

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Data availability

 The data that support the fndings of this study are available on request from the corresponding author, YN.

References

  1. Chirodian N, Arch B, Parker MJ. Sliding hip screw fixation of trochanteric hip fractures: outcome of 1024 procedures. Injury. 2005;36:793.

    Article  CAS  PubMed  Google Scholar 

  2. Larson S, Friberg S, Hanssonl LI. Trochanteric fractures. Mobility, complications, and mortality in 607 cases treated with the sliding-screw technique. Clin Orthop Relat Res. 1990;260:232–41.

    Google Scholar 

  3. Chen LK, Woo J, Assantachai P, Auyeung TW, Chou MY, Iijima K, Jang HC, Kang L, Kim M, Kim S, Kojima T, Kuzuya M, Lee JSW, Lee SY, Lee WJ, Lee Y, Liang CK, Lim JY, Lim WS, Peng LN, Sugimoto K, Tanaka T, Won CW, Yamada M, Zhang T, Akishita M, Arai H. Asian working group for sarcopnia 2019 consensus update on sarcopenia diagnosis and treatment. J Am Med Dir Assoc. 2020;21:300-307.e2.

    Article  PubMed  Google Scholar 

  4. Cruz-Jentoft AJ, Bahat G, Bauer J, Boirie Y, Bruyère O, Cederholm T, Cooper C, Landi F, Rolland Y, Sayer AA, Schneider SM, Sieber CC, Topinkova E, Vandewoude M, Visser M, Zamboni M. Writing group for the European working group on sarcopenia in older people 2 (EWGSOP2), and the extended group for EWGSOP2: sarcopenia: revised European consensus on definition and diagnosis. Age Aging. 2019;48:16–31.

    Article  Google Scholar 

  5. Hamaguchi Y, Kaido T, Okumura S, Kobayashi A, Hammad A, Tamai Y, Inagaki N, Uemoto S. Proposal for new diagnostic criteria for low skeletal muscle, as based on computed tomography imaging in Asian adults. Nutrition. 2016;32:1200–5.

    Article  PubMed  Google Scholar 

  6. Kawakami T, Imagama T, Murakami T, Kaneoka T, Yamamoto M. Low psoas major muscle area as a risk factor for contralateral hip fracture following intertrochanteric fracture. J Musculoskelet Netronal Interact. 2021;21:495–500.

    Google Scholar 

  7. Kojima G, Iliffe S, Taniguchi Y, Shimada H, Rakugi H, Walters K. Prevalence of frailty in Japan: a systematic review and meta-analysis. J Epidemiol. 2017;27:347–53.

  8. Brox WT, Chan PH, Cafri G, Inacio MCS. Similar mortality with general or regional anesthesia in elderly hip fracture patients. Acta Orthop. 2016;87:152–7.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Waesberghe JV, Stevanovic A, Rossaint R, Coburn M. General vs. neuraxial anaesthesia in hip fracture patients: a systematic review and meta-analysis. BMC Anesthesiol. 2017;17:87.

    Article  PubMed  PubMed Central  Google Scholar 

  10. White SM, Moppett IK, Griffiths R. Outcome by mode of anaesthesia for hip fracture surgery. An observational audit of 65 535 patients in a national dataset. Anaesthesia. 2014;69:224–30.

    Article  CAS  PubMed  Google Scholar 

  11. Neuman MD, Feng R, Carson JL, Gaskins LJ, Dillane D, Sessler DI, Sieber F, Magaziner J, Marcantonio ER, Mehta S, Menio D, Ayad S, Stone T, Papp S, Schwenk ES, Elkassabany N, Marshall M, Jaffe JD, Luke C, Sharma B, Azim S, Hymes RA, Chin RJ, Sheppard R, Perlman B, Sappenfield J, Hauck E, Hoeft MA, Giska M, Ranganath Y, Tedore T, Choi S, Li J, Kwofie MK, Nader A, Sanders RD, Allen BFS, Vlassakov K, Kates S, Fleisher LA, Dattilo J, Tierney A, Stephens-Shields AJ, Ellenberg SS, REGAIN Investigators. Spinal anesthesia or general anesthesia for hip surgery in older adults. N Engl J Med. 2021;385:2025–35.

    Article  CAS  PubMed  Google Scholar 

  12. Li T, Li J, Yuan L, Wu J, Jian C, Daniels J, Mehta RL, Wang M, Yeung J, Jackson T, Melody T, Jin S, Yao Y, Wu J, Chen J, Smith FG, Lian Q, RAGA Study Investigators. Effect of regional vs general anesthesia on incidence of postoperative delirium in older patients undergoing hip fracture surgery: the RAGA randomized trial. JAMA. 2022;327:50–8.

    Article  CAS  PubMed  Google Scholar 

  13. Lattermann R, Belohlavek G, Wittmann S, Füchtmeier B, Gruber M. The anticatabolic effect of neuraxial blockade after hip surgery. Anesth Analg. 2005;101:1202–8.

    Article  PubMed  Google Scholar 

  14. Salminen S, Pihlajamäki H, Avikainen V, Kyrö A, Böstman O. Specific features associated with femoral shaft fractures caused by low-energy trauma. J Trauma. 1997;43:117–22.

    Article  CAS  PubMed  Google Scholar 

  15. Batista AFR, Petty D, Fairhurst C, Davies S. Psoas muscle mass index as a predictor of long-term mortality and severity of complications after major intra-abdominal colorectal surgery—a retrospective analysis. J Clin Anesth. 2023;84: 110995.

    Article  PubMed  Google Scholar 

  16. Dionyssiotis Y, Athanassiou P, Papathanasiou J, Efstathopoulos E, Prokopidis K, Trovas G, Kostoglou-Athanassiou I. Sarcopenia in patients with diabetes mellitus. Folia Med (Plovdiv). 2022;64:596–601.

    Article  CAS  PubMed  Google Scholar 

  17. Jensen GL, Cederholm T, Correia MITD, Gonzalez MC, Fukushima R, Higashiguchi T, Baptista GA, Barazzoni R, Blaauw R, Coats AJS, Crivelli A, Evans DC, Gramlich L, Fuchs-Tarlovsky V, Keller H, Llido L, Malone A, Mogensen KM, Morley JE, Muscaritoli M, Nyulasi I, Pirlich M, Pisprasert V, Schueren M, Siltharm S, Singer P, Tappenden KA, Velasco N, Waitzberg DL, Yamwong P, Yu J, Compher C, Gossum AV. GLIM criteria for the diagnosis of malnutrition e A consensus report from the global clinical nutrition community. JPEN J Parenter Enteral Nutr. 2019;43:32–40.

    Article  PubMed  Google Scholar 

  18. Itoh S, Yoshizumi T, Tomiyama T, Iseda N, Morinaga A, Shimagaki T, Wang H, Kurihara T, Nagao Y, Toshima T, Harada N, Nishie A, Ishigami K, Mori M. Impact and risk factors for skeletal muscle mass loss after hepatic resection in patients with hepatocellular carcinoma. JGH Open. 2021;5:785–92.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Hardy EJ, Hatt J, Doleman B, Smart TF, Piasecki M, Lund JN, Phillips BE. Post-operative electrical muscle stimulation attenuates loss of muscle mass and function following major abdominal surgery in older adults: a split body randomised control trial. Age Ageing. 2022;51:afac234.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Wall BT, Loon LJC. Nutritional strategies to attenuate muscle disuse atrophy. Nutr Rev. 2013;71:195–208.

    Article  PubMed  Google Scholar 

  21. Wall BT, Dirks ML, Loon LJC. Skeletal muscle atrophy during short-term disuse: implications for age-related sarcopenia. Ageing Res Rev. 2013;12:898–906.

    Article  CAS  PubMed  Google Scholar 

  22. Kanda Y. Investigation of the freely available easy-to-use software ‘EZR’ for medical statistics. Bone Marrow Transplant. 2013;48:452–8.

    Article  CAS  PubMed  Google Scholar 

  23. Griffiths R, Babu S, Dixon P, Freeman N, Hurford D, Kelleher E, Moppett I, Ray D, Sahota O, Shields M, White M. Guidelines for the management of hip fractures 2020. Anaesthesia. 2021;76:225–37.

    Article  CAS  PubMed  Google Scholar 

  24. Hamaguchi Y, Kaido T, Okumura S, Fujimoto Y, Ogawa K, Mori A, Hammad A, Tamai Y, Inagaki N, Uemoto S. Impact of quality as well as quantity of skeletal muscle on outcomes after liver transplantation. Liver Transpl. 2014;20:1413–9.

    Article  PubMed  Google Scholar 

  25. Ito E, Ohki T, Toya N, Fukushima S, Murakami Y, Nakagawa H, Nishie R, Misawa T. Sarcopenia aneurysm scoring system predicts early and midterm mortality after endvascular repair for abdominal aortic aneurysm. Ann Surg. 2022;276:e247–54.

    Article  PubMed  Google Scholar 

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Funding

This research did not receive any specific grant from any public, commercial, or nonprofit funding agency.

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Authors and Affiliations

  1. Department of Anesthesiology, Aidu Chuo Hospital, 1-1, Tsuruga-Machi, Aizuwakamatsu, Fukushima, 965-8611, Japan

    Yoshie Noji & Kazuhiro Watanabe

  2. Department of Anesthesiology, Fukushima Medical University, Fukushima, Japan

    Yoshie Noji, Satoki Inoue & Shinju Obara

Authors
  1. Yoshie Noji
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  2. Satoki Inoue
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  3. Kazuhiro Watanabe
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  4. Shinju Obara
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Contributions

YN designed the study, acquired the data, and prepared the manuscript. SI assisted in the preparation of the manuscript and statistical analysis. KW acquired the data. SO assisted in the conception and design of the study. All authors have read and approved the final manuscript.

Corresponding author

Correspondence to Yoshie Noji.

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The authors declare no conflicts of interest.

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Noji, Y., Inoue, S., Watanabe, K. et al. Perioperative loss of the psoas major muscle area index in elderly patients with hip fracture: spinal anesthesia versus general anesthesia—a retrospective cohort study. J Anesth 38, 57–64 (2024). https://doi.org/10.1007/s00540-023-03278-1

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  • DOI: https://doi.org/10.1007/s00540-023-03278-1

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