PDF(Pubmed)
Abstract：
Sarcopenia refers to the progressive age- or pathology-associated loss of skeletal muscle. When measured radiologically as reduced muscle mass, sarcopenia has been shown to independently predict morbidity and mortality after elective abdominal surgery. However, the European Working Group on Sarcopenia in Older People (EWGSOP) recently updated their sarcopenia definition, emphasizing both low muscle \'strength\' and \'mass\'. The aim of this systematic review and meta-analysis was to determine the prognostic impact of this updated consensus definition of sarcopenia after elective abdominal surgery.
MEDLINE, Embase, Scopus, and Cochrane Central Register of Controlled Trials (CENTRAL) databases were systematically searched for studies comparing prognostic outcomes between sarcopenic versus non-sarcopenic adults after elective abdominal surgery from inception to 15 June 2022. The primary outcomes were postoperative morbidity and mortality. Sensitivity analyses adjusting for confounding patient factors were also performed. Methodological quality assessment of studies was performed independently by two authors using the QUality in Prognosis Studies (QUIPS) tool.
Twenty articles with 5421 patients (1059 sarcopenic and 4362 non-sarcopenic) were included. Sarcopenic patients were at significantly greater risk of incurring postoperative complications, despite adjusted multivariate analysis (adjusted OR 1.56, 95 per cent c.i. 1.39 to 1.76). Sarcopenic patients also had significantly higher rates of in-hospital (OR 7.62, 95 per cent c.i. 2.86 to 20.34), 30-day (OR 3.84, 95 per cent c.i. 1.27 to 11.64), and 90-day (OR 3.73, 95 per cent c.i. 1.19 to 11.70) mortality. Sarcopenia was an independent risk factor for poorer overall survival in multivariate Cox regression analysis (adjusted HR 1.28, 95 per cent c.i. 1.13 to 1.44).
Consensus-defined sarcopenia provides important prognostic information after elective abdominal surgery and can be appropriately measured in the preoperative setting. Development of targeted exercise-based interventions that minimize sarcopenia may improve outcomes for patients who are undergoing elective abdominal surgery.
MEDLINE, Embase, Scopus, and Cochrane Central Register of Controlled Trials (CENTRAL) databases were systematically searched for studies comparing prognostic outcomes between sarcopenic versus non-sarcopenic adults after elective abdominal surgery from inception to 15 June 2022. The primary outcomes were postoperative morbidity and mortality. Sensitivity analyses adjusting for confounding patient factors were also performed. Methodological quality assessment of studies was performed independently by two authors using the QUality in Prognosis Studies (QUIPS) tool.
Twenty articles with 5421 patients (1059 sarcopenic and 4362 non-sarcopenic) were included. Sarcopenic patients were at significantly greater risk of incurring postoperative complications, despite adjusted multivariate analysis (adjusted OR 1.56, 95 per cent c.i. 1.39 to 1.76). Sarcopenic patients also had significantly higher rates of in-hospital (OR 7.62, 95 per cent c.i. 2.86 to 20.34), 30-day (OR 3.84, 95 per cent c.i. 1.27 to 11.64), and 90-day (OR 3.73, 95 per cent c.i. 1.19 to 11.70) mortality. Sarcopenia was an independent risk factor for poorer overall survival in multivariate Cox regression analysis (adjusted HR 1.28, 95 per cent c.i. 1.13 to 1.44).
Consensus-defined sarcopenia provides important prognostic information after elective abdominal surgery and can be appropriately measured in the preoperative setting. Development of targeted exercise-based interventions that minimize sarcopenia may improve outcomes for patients who are undergoing elective abdominal surgery.
摘要：
背景：肌肉减少症是指进行性年龄或病理相关的骨骼肌损失。当放射学测量为肌肉质量减少时，肌肉减少症已被证明可以独立预测择期腹部手术后的发病率和死亡率。然而,欧洲老年人肌肉减少症工作组（EWGSOP）最近更新了其肌肉减少症的定义，强调低肌肉“力量”和“质量”。本系统评价和荟萃分析的目的是确定择期腹部手术后肌肉减少症的最新共识定义对预后的影响。
方法：MEDLINE，Embase,Scopus,系统搜索Cochrane中央对照试验注册中心(CENTRAL)数据库,以比较从开始至2022年6月15日进行腹部择期手术后少肌症患者与非少肌症患者之间的预后结局.主要结果是术后发病率和死亡率。还进行了调整混杂患者因素的敏感性分析。研究的方法学质量评估由两名作者使用预后研究质量（QUIPS）工具独立进行。
结果：纳入了20篇文献，5421例患者（1059例非节肌症和4362例非节肌症）。肌肉减少症患者发生术后并发症的风险显著增加，尽管进行了调整后的多变量分析(调整后的OR为1.56，95%c.i.1.39至1.76)。肌肉减少症患者的住院率也显着较高（OR7.62，95％c.i.2.86至20.34），30天(OR3.84，95%c.i.1.27至11.64)，和90天(OR3.73，95%c.i.1.19至11.70)死亡率。在多变量Cox回归分析中，肌肉减少是总生存期较差的独立危险因素（校正HR1.28，95％c.i.1.13至1.44）。
结论：共识定义的少肌症在择期腹部手术后提供了重要的预后信息，可以在术前进行适当的测量。开发有针对性的基于运动的干预措施，以最大程度地减少肌肉减少症，可能会改善接受择期腹部手术的患者的预后。
方法：MEDLINE，Embase,Scopus,系统搜索Cochrane中央对照试验注册中心(CENTRAL)数据库,以比较从开始至2022年6月15日进行腹部择期手术后少肌症患者与非少肌症患者之间的预后结局.主要结果是术后发病率和死亡率。还进行了调整混杂患者因素的敏感性分析。研究的方法学质量评估由两名作者使用预后研究质量（QUIPS）工具独立进行。
结果：纳入了20篇文献，5421例患者（1059例非节肌症和4362例非节肌症）。肌肉减少症患者发生术后并发症的风险显著增加，尽管进行了调整后的多变量分析(调整后的OR为1.56，95%c.i.1.39至1.76)。肌肉减少症患者的住院率也显着较高（OR7.62，95％c.i.2.86至20.34），30天(OR3.84，95%c.i.1.27至11.64)，和90天(OR3.73，95%c.i.1.19至11.70)死亡率。在多变量Cox回归分析中，肌肉减少是总生存期较差的独立危险因素（校正HR1.28，95％c.i.1.13至1.44）。
结论：共识定义的少肌症在择期腹部手术后提供了重要的预后信息，可以在术前进行适当的测量。开发有针对性的基于运动的干预措施，以最大程度地减少肌肉减少症，可能会改善接受择期腹部手术的患者的预后。
