Sarcopenia Increased Postoperative Complications in Elderly with IBD, States study

A recent retrospective study has shed light on the significant impact of sarcopenia on postoperative outcomes in older adults with inflammatory bowel disease (IBD). The research published in the journal of Inflammatory Bowel Disease highlighted the need for improved preoperative risk assessment in this vulnerable population.

The study focused on patients aged 60 years and older who underwent disease-related intestinal resection between 2012 and 2022. A total of 120 individuals were included, with a near-equal distribution of men and women. The median age at the time of surgery was 70 years, and the group was composed of patients with either ulcerative colitis (40%) or Crohn’s disease (60%).

This study assess the predictive value of two measures of muscle mass—Skeletal Muscle Index (SMI) and Total Psoas Index (TPI)—obtained from preoperative computed tomography (CT) scans. The SMI was found to be a more reliable predictor of adverse 30-day postoperative outcomes compared to TPI. Also, SMI demonstrated a higher area under the curve (AUC) in the receiver operating characteristic analysis, with an AUC of 0.66, significantly outperforming TPI, which had an AUC of 0.58.

The study revealed that 40% of the older adults experienced adverse outcomes within 30 days following surgery. These complications included infection (23%), readmission (17%), acute kidney injury (13%), and bleeding (13%), among others. 5% of the cohort succumbed to mortality within this period. The findings underscore the importance of early identification of high-risk individuals to reduce postoperative complications.

Multivariable logistic regression analysis further highlighted key risk factors associated with adverse outcomes. Prior IBD-related surgery and preoperative sepsis were both found to significantly increase the risk of complications, with adjusted odds ratios (adjOR) of 6.46 and 5.74, respectively. An increase in SMI was associated with a reduced risk of adverse outcomes, with an adjOR of 0.88, indicating that higher muscle mass could potentially confer protective benefits.

The findings have important implications for the management of older adults with IBD. Given the association between sarcopenia and poorer postoperative outcomes by measuring SMI through preoperative imaging could become a valuable tool for risk stratification. Overall, this study highlights the critical role of sarcopenia in influencing postoperative outcomes in older adults with IBD. As the population ages, integrating muscle mass assessments into preoperative evaluations may improve patient care and reduce the burden of postoperative complications.

Reference:

Minawala, R., Kim, M., Delau, O., Ghiasian, G., McKenney, A. S., Da Luz Moreira, A., Chodosh, J., McAdams-DeMarco, M., Segev, D. L., Adhikari, S., Dodson, J., Shaukat, A., Dane, B., & Faye, A. S. (2024). Sarcopenia Is a Risk Factor for Postoperative Complications Among Older Adults With Inflammatory Bowel Disease. In Inflammatory Bowel Diseases. Oxford University Press (OUP). https://doi.org/10.1093/ibd/izae187