Effect of sarcopenia on survival and spinal cord deficit outcomes after thoracoabdominal aortic aneurysm repair in patients 60 years of age and older
Sarcopenia (core muscle loss) has been used as a surrogate marker of frailty. We investigated whether sarcopenia would adversely affect survival after thoracoabdominal aortic aneurysm repair. We retrospectively reviewed prospectively collected data from patients aged 60 years or older who underwent...
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| Veröffentlicht in: | The Journal of thoracic and cardiovascular surgery 2023-06, Vol.165 (6), p.1985-1996.e3 |
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| container_end_page | 1996.e3 |
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| container_issue | 6 |
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| container_title | The Journal of thoracic and cardiovascular surgery |
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| creator | Chatterjee, Subhasis Shi, Ann Yoon, Luke Green, Susan Y. Zhang, Qianzi Amarasekara, Hiruni S. Orozco-Sevilla, Vicente Preventza, Ourania LeMaire, Scott A. Coselli, Joseph S. |
| description | Sarcopenia (core muscle loss) has been used as a surrogate marker of frailty. We investigated whether sarcopenia would adversely affect survival after thoracoabdominal aortic aneurysm repair.
We retrospectively reviewed prospectively collected data from patients aged 60 years or older who underwent thoracoabdominal aortic aneurysm repairs from 2006 to 2016. Imaging was reviewed by 2 radiologists blinded to clinical outcomes. The total psoas index was derived from total psoas muscle cross-sectional area (cm2) at the mid-L4 level, normalized for height (m2). Patients were divided by sex-specific total psoas index values into sarcopenia (lower third) and nonsarcopenia (upper two-thirds) groups. Multivariable modeling identified operative mortality and spinal cord injury predictors. Unadjusted and adjusted survival curves were analyzed.
Of 392 patients identified, those with sarcopenia (n = 131) were older than nonsarcopenic patients (n = 261) (70.0 years vs 68.0 years; P = .02) and more frequently presented with aortic rupture or required urgent/emergency operations. Operative mortality was comparable (sarcopenia 13.7% vs nonsarcopenia 10.0%; P = .3); sarcopenia was not associated with operative mortality in the multivariable model (odds ratio, 1.40; 95% confidence interval, 0.73-2.77; P = .3). Sarcopenic patients experienced more frequent delayed (13.0% vs 4.6%; P = .005) and persistent (10.7% vs 3.4%; P = .008) paraplegia. Sarcopenia independently predicted delayed paraplegia (odds ratio, 3.17; 95% confidence interval, 1.42-7.08; P = .005) and persistent paraplegia (odds ratio, 3.29; 95% confidence interval, 1.33-8.13; P = .01) in the multivariable model. Adjusted for preoperative/operative covariates, midterm survival was similar for sarcopenic and nonsarcopenic patients (P = .3).
Sarcopenia did not influence early mortality or midterm survival after thoracoabdominal aortic aneurysm repair but was associated with greater risk for delayed and persistent paraplegia.
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| doi_str_mv | 10.1016/j.jtcvs.2021.05.037 |
| format | Article |
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We retrospectively reviewed prospectively collected data from patients aged 60 years or older who underwent thoracoabdominal aortic aneurysm repairs from 2006 to 2016. Imaging was reviewed by 2 radiologists blinded to clinical outcomes. The total psoas index was derived from total psoas muscle cross-sectional area (cm2) at the mid-L4 level, normalized for height (m2). Patients were divided by sex-specific total psoas index values into sarcopenia (lower third) and nonsarcopenia (upper two-thirds) groups. Multivariable modeling identified operative mortality and spinal cord injury predictors. Unadjusted and adjusted survival curves were analyzed.
Of 392 patients identified, those with sarcopenia (n = 131) were older than nonsarcopenic patients (n = 261) (70.0 years vs 68.0 years; P = .02) and more frequently presented with aortic rupture or required urgent/emergency operations. Operative mortality was comparable (sarcopenia 13.7% vs nonsarcopenia 10.0%; P = .3); sarcopenia was not associated with operative mortality in the multivariable model (odds ratio, 1.40; 95% confidence interval, 0.73-2.77; P = .3). Sarcopenic patients experienced more frequent delayed (13.0% vs 4.6%; P = .005) and persistent (10.7% vs 3.4%; P = .008) paraplegia. Sarcopenia independently predicted delayed paraplegia (odds ratio, 3.17; 95% confidence interval, 1.42-7.08; P = .005) and persistent paraplegia (odds ratio, 3.29; 95% confidence interval, 1.33-8.13; P = .01) in the multivariable model. Adjusted for preoperative/operative covariates, midterm survival was similar for sarcopenic and nonsarcopenic patients (P = .3).
Sarcopenia did not influence early mortality or midterm survival after thoracoabdominal aortic aneurysm repair but was associated with greater risk for delayed and persistent paraplegia.
[Display omitted]</description><identifier>ISSN: 0022-5223</identifier><identifier>EISSN: 1097-685X</identifier><identifier>DOI: 10.1016/j.jtcvs.2021.05.037</identifier><identifier>PMID: 34147254</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>aortic aneurysm ; Aortic Aneurysm, Abdominal - surgery ; Aortic Aneurysm, Thoracic - complications ; Aortic Aneurysm, Thoracic - diagnostic imaging ; Aortic Aneurysm, Thoracic - surgery ; Aortic Aneurysm, Thoracoabdominal ; Blood Vessel Prosthesis Implantation ; Female ; frailty ; Humans ; Male ; Middle Aged ; Paraplegia ; psoas muscles ; Retrospective Studies ; Risk Assessment ; Risk Factors ; sarcopenia ; Sarcopenia - complications ; Sarcopenia - diagnostic imaging ; Spinal Cord ; survival ; thoracic ; Treatment Outcome</subject><ispartof>The Journal of thoracic and cardiovascular surgery, 2023-06, Vol.165 (6), p.1985-1996.e3</ispartof><rights>2021 The American Association for Thoracic Surgery</rights><rights>Copyright © 2021 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c425t-37d6d6a8dee22b16db8338cc12f975e98ff965b8eebe6f365649d1c166fd9eee3</citedby><cites>FETCH-LOGICAL-c425t-37d6d6a8dee22b16db8338cc12f975e98ff965b8eebe6f365649d1c166fd9eee3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0022522321008825$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34147254$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Chatterjee, Subhasis</creatorcontrib><creatorcontrib>Shi, Ann</creatorcontrib><creatorcontrib>Yoon, Luke</creatorcontrib><creatorcontrib>Green, Susan Y.</creatorcontrib><creatorcontrib>Zhang, Qianzi</creatorcontrib><creatorcontrib>Amarasekara, Hiruni S.</creatorcontrib><creatorcontrib>Orozco-Sevilla, Vicente</creatorcontrib><creatorcontrib>Preventza, Ourania</creatorcontrib><creatorcontrib>LeMaire, Scott A.</creatorcontrib><creatorcontrib>Coselli, Joseph S.</creatorcontrib><title>Effect of sarcopenia on survival and spinal cord deficit outcomes after thoracoabdominal aortic aneurysm repair in patients 60 years of age and older</title><title>The Journal of thoracic and cardiovascular surgery</title><addtitle>J Thorac Cardiovasc Surg</addtitle><description>Sarcopenia (core muscle loss) has been used as a surrogate marker of frailty. We investigated whether sarcopenia would adversely affect survival after thoracoabdominal aortic aneurysm repair.
We retrospectively reviewed prospectively collected data from patients aged 60 years or older who underwent thoracoabdominal aortic aneurysm repairs from 2006 to 2016. Imaging was reviewed by 2 radiologists blinded to clinical outcomes. The total psoas index was derived from total psoas muscle cross-sectional area (cm2) at the mid-L4 level, normalized for height (m2). Patients were divided by sex-specific total psoas index values into sarcopenia (lower third) and nonsarcopenia (upper two-thirds) groups. Multivariable modeling identified operative mortality and spinal cord injury predictors. Unadjusted and adjusted survival curves were analyzed.
Of 392 patients identified, those with sarcopenia (n = 131) were older than nonsarcopenic patients (n = 261) (70.0 years vs 68.0 years; P = .02) and more frequently presented with aortic rupture or required urgent/emergency operations. Operative mortality was comparable (sarcopenia 13.7% vs nonsarcopenia 10.0%; P = .3); sarcopenia was not associated with operative mortality in the multivariable model (odds ratio, 1.40; 95% confidence interval, 0.73-2.77; P = .3). Sarcopenic patients experienced more frequent delayed (13.0% vs 4.6%; P = .005) and persistent (10.7% vs 3.4%; P = .008) paraplegia. Sarcopenia independently predicted delayed paraplegia (odds ratio, 3.17; 95% confidence interval, 1.42-7.08; P = .005) and persistent paraplegia (odds ratio, 3.29; 95% confidence interval, 1.33-8.13; P = .01) in the multivariable model. Adjusted for preoperative/operative covariates, midterm survival was similar for sarcopenic and nonsarcopenic patients (P = .3).
Sarcopenia did not influence early mortality or midterm survival after thoracoabdominal aortic aneurysm repair but was associated with greater risk for delayed and persistent paraplegia.
[Display omitted]</description><subject>aortic aneurysm</subject><subject>Aortic Aneurysm, Abdominal - surgery</subject><subject>Aortic Aneurysm, Thoracic - complications</subject><subject>Aortic Aneurysm, Thoracic - diagnostic imaging</subject><subject>Aortic Aneurysm, Thoracic - surgery</subject><subject>Aortic Aneurysm, Thoracoabdominal</subject><subject>Blood Vessel Prosthesis Implantation</subject><subject>Female</subject><subject>frailty</subject><subject>Humans</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Paraplegia</subject><subject>psoas muscles</subject><subject>Retrospective Studies</subject><subject>Risk Assessment</subject><subject>Risk Factors</subject><subject>sarcopenia</subject><subject>Sarcopenia - complications</subject><subject>Sarcopenia - diagnostic imaging</subject><subject>Spinal Cord</subject><subject>survival</subject><subject>thoracic</subject><subject>Treatment Outcome</subject><issn>0022-5223</issn><issn>1097-685X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kbuO1DAUhi0EYoeFJ0BCLmkSfEmcpKBAq-UirUQDEp3l2MfgURKHY2ekeZGteRaeDM_MQkllF9_v3-d8hLzkrOaMqzf7ep_tIdWCCV6ztmaye0R2nA1dpfr222OyY0yIqhVCXpFnKe0ZYx3jw1NyJRvedKJtduT-1nuwmUZPk0EbV1iCoXGhacNDOJiJmsXRtIalXG1ERx34YENJbNnGGRI1PgPS_COisdGMLs5n2ETMwZY4bHhMM0VYTUAaFrqaHGDJiSr2-9cRDKZTvfkO5644OcDn5Ik3U4IXD-c1-fr-9svNx-ru84dPN-_uKtuINleyc8op0zsAIUau3NhL2VvLhR-6Fobe-0G1Yw8wgvJStaoZHLdcKe8GAJDX5PXl3RXjzw1S1nNIFqapfDtuSZcdyY71neIFlRfUYkwJwesVw2zwqDnTJyF6r89C9EmIZq0uQkrq1UPBNs7g_mX-GijA2wsAZcxDANTJlu1YcAGLGO1i-G_BH_asogQ</recordid><startdate>202306</startdate><enddate>202306</enddate><creator>Chatterjee, Subhasis</creator><creator>Shi, Ann</creator><creator>Yoon, Luke</creator><creator>Green, Susan Y.</creator><creator>Zhang, Qianzi</creator><creator>Amarasekara, Hiruni S.</creator><creator>Orozco-Sevilla, Vicente</creator><creator>Preventza, Ourania</creator><creator>LeMaire, Scott A.</creator><creator>Coselli, Joseph S.</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>202306</creationdate><title>Effect of sarcopenia on survival and spinal cord deficit outcomes after thoracoabdominal aortic aneurysm repair in patients 60 years of age and older</title><author>Chatterjee, Subhasis ; Shi, Ann ; Yoon, Luke ; Green, Susan Y. ; Zhang, Qianzi ; Amarasekara, Hiruni S. ; Orozco-Sevilla, Vicente ; Preventza, Ourania ; LeMaire, Scott A. ; Coselli, Joseph S.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c425t-37d6d6a8dee22b16db8338cc12f975e98ff965b8eebe6f365649d1c166fd9eee3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>aortic aneurysm</topic><topic>Aortic Aneurysm, Abdominal - surgery</topic><topic>Aortic Aneurysm, Thoracic - complications</topic><topic>Aortic Aneurysm, Thoracic - diagnostic imaging</topic><topic>Aortic Aneurysm, Thoracic - surgery</topic><topic>Aortic Aneurysm, Thoracoabdominal</topic><topic>Blood Vessel Prosthesis Implantation</topic><topic>Female</topic><topic>frailty</topic><topic>Humans</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Paraplegia</topic><topic>psoas muscles</topic><topic>Retrospective Studies</topic><topic>Risk Assessment</topic><topic>Risk Factors</topic><topic>sarcopenia</topic><topic>Sarcopenia - complications</topic><topic>Sarcopenia - diagnostic imaging</topic><topic>Spinal Cord</topic><topic>survival</topic><topic>thoracic</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Chatterjee, Subhasis</creatorcontrib><creatorcontrib>Shi, Ann</creatorcontrib><creatorcontrib>Yoon, Luke</creatorcontrib><creatorcontrib>Green, Susan Y.</creatorcontrib><creatorcontrib>Zhang, Qianzi</creatorcontrib><creatorcontrib>Amarasekara, Hiruni S.</creatorcontrib><creatorcontrib>Orozco-Sevilla, Vicente</creatorcontrib><creatorcontrib>Preventza, Ourania</creatorcontrib><creatorcontrib>LeMaire, Scott A.</creatorcontrib><creatorcontrib>Coselli, Joseph S.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>The Journal of thoracic and cardiovascular surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Chatterjee, Subhasis</au><au>Shi, Ann</au><au>Yoon, Luke</au><au>Green, Susan Y.</au><au>Zhang, Qianzi</au><au>Amarasekara, Hiruni S.</au><au>Orozco-Sevilla, Vicente</au><au>Preventza, Ourania</au><au>LeMaire, Scott A.</au><au>Coselli, Joseph S.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Effect of sarcopenia on survival and spinal cord deficit outcomes after thoracoabdominal aortic aneurysm repair in patients 60 years of age and older</atitle><jtitle>The Journal of thoracic and cardiovascular surgery</jtitle><addtitle>J Thorac Cardiovasc Surg</addtitle><date>2023-06</date><risdate>2023</risdate><volume>165</volume><issue>6</issue><spage>1985</spage><epage>1996.e3</epage><pages>1985-1996.e3</pages><issn>0022-5223</issn><eissn>1097-685X</eissn><abstract>Sarcopenia (core muscle loss) has been used as a surrogate marker of frailty. We investigated whether sarcopenia would adversely affect survival after thoracoabdominal aortic aneurysm repair.
We retrospectively reviewed prospectively collected data from patients aged 60 years or older who underwent thoracoabdominal aortic aneurysm repairs from 2006 to 2016. Imaging was reviewed by 2 radiologists blinded to clinical outcomes. The total psoas index was derived from total psoas muscle cross-sectional area (cm2) at the mid-L4 level, normalized for height (m2). Patients were divided by sex-specific total psoas index values into sarcopenia (lower third) and nonsarcopenia (upper two-thirds) groups. Multivariable modeling identified operative mortality and spinal cord injury predictors. Unadjusted and adjusted survival curves were analyzed.
Of 392 patients identified, those with sarcopenia (n = 131) were older than nonsarcopenic patients (n = 261) (70.0 years vs 68.0 years; P = .02) and more frequently presented with aortic rupture or required urgent/emergency operations. Operative mortality was comparable (sarcopenia 13.7% vs nonsarcopenia 10.0%; P = .3); sarcopenia was not associated with operative mortality in the multivariable model (odds ratio, 1.40; 95% confidence interval, 0.73-2.77; P = .3). Sarcopenic patients experienced more frequent delayed (13.0% vs 4.6%; P = .005) and persistent (10.7% vs 3.4%; P = .008) paraplegia. Sarcopenia independently predicted delayed paraplegia (odds ratio, 3.17; 95% confidence interval, 1.42-7.08; P = .005) and persistent paraplegia (odds ratio, 3.29; 95% confidence interval, 1.33-8.13; P = .01) in the multivariable model. Adjusted for preoperative/operative covariates, midterm survival was similar for sarcopenic and nonsarcopenic patients (P = .3).
Sarcopenia did not influence early mortality or midterm survival after thoracoabdominal aortic aneurysm repair but was associated with greater risk for delayed and persistent paraplegia.
[Display omitted]</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>34147254</pmid><doi>10.1016/j.jtcvs.2021.05.037</doi></addata></record> |
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| subjects | aortic aneurysm Aortic Aneurysm, Abdominal - surgery Aortic Aneurysm, Thoracic - complications Aortic Aneurysm, Thoracic - diagnostic imaging Aortic Aneurysm, Thoracic - surgery Aortic Aneurysm, Thoracoabdominal Blood Vessel Prosthesis Implantation Female frailty Humans Male Middle Aged Paraplegia psoas muscles Retrospective Studies Risk Assessment Risk Factors sarcopenia Sarcopenia - complications Sarcopenia - diagnostic imaging Spinal Cord survival thoracic Treatment Outcome |
| title | Effect of sarcopenia on survival and spinal cord deficit outcomes after thoracoabdominal aortic aneurysm repair in patients 60 years of age and older |
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