Preoperative sarcopenia is a negative predictor for enhanced postoperative recovery after pancreaticoduodenectomy.
Publication/Presentation Date
9-1-2022
Abstract
PURPOSE: Sarcopenia is common in pancreatic cancer patients. Considering the growing adoption of standardized protocols for enhanced recovery after surgery (ERAS), we examined the clinical impact of sarcopenia in pancreaticoduodenectomy (PD) patients in a 5-day accelerated ERAS program, termed the Whipple Accelerated Recovery Pathway.
METHODS: A retrospective review was conducted of patients undergoing PD from 2017 through 2020 on the ERAS pathway. Preoperative computerized tomographic scans taken within 45 days before surgery were analyzed to determine psoas muscle cross-sectional area (PMA) at the third lumbar vertebral body. Sarcopenia was defined as the lowest quartile of PMA respective to gender. Outcome measures were compared between patients with or without sarcopenia.
RESULTS: In this 333-patient cohort, 252 (75.7%) patients had final pathology revealing pancreatic or periampullary cancer. The median age was 66.7 years (16.4-88.4 years) with a 161:172 male to female ratio. Sarcopenia correlated with delayed tolerance of oral intake (OR 2.2; 95%CI 1.1-4.3, P = 0.03), increased complication rates (OR 4.3; 95%CI 2.2-8.5, P < 0.01), and longer hospital length of stay (LOS) (P < 0.05). Preoperative albumin levels, BMI, and history of pancreatitis were also found to correlate with LOS (P < 0.05). Multivariate regression analysis found low PMA, BMI, and male gender to be independent predictors of increased LOS (P < 0.05).
CONCLUSION: Sarcopenia correlated with increased LOS and postoperative complications in ERAS patients after PD. Sarcopenia can be used to predict poor candidates for ERAS protocols who may require an alternative recovery protocol, promoting a clinical tier-based approach to ERAS for pancreatic surgery.
Volume
407
Issue
6
First Page
2355
Last Page
2362
ISSN
1435-2451
Published In/Presented At
Nauheim, D. O., Hackbart, H., Papai, E., Moskal, D., Yeo, C. J., Lavu, H., & Nevler, A. (2022). Preoperative sarcopenia is a negative predictor for enhanced postoperative recovery after pancreaticoduodenectomy. Langenbeck's archives of surgery, 407(6), 2355–2362. https://doi.org/10.1007/s00423-022-02558-w
Disciplines
Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods
PubMedID
35593934
Department(s)
Administration and Leadership
Document Type
Article