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The Role of Body Composition in Predicting Outcomes in the Elderly Following Acute Abdominal Surgery

  • Author / Creator
    Alghamdi, Mahmoud H
  • Background:The elderly are the fastest growing population in North America which has resulted in rising number of older patients undergoing emergency surgery. Often with aging, there is a decrease in skeletal muscle mass and an increase in intra-abdominal fat. Sarcopenia, severe muscle depletion, as identified by computed tomography (CT) has been found to be a strong predictor of poor outcomes following surgery. There is much less knowledge on the role of visceral and subcutaneous fat. Therefore, the aim of this study was to examine the association of body composition identified by CT scan with in-hospital mortality and postoperative complications after acute abdominal surgery in elderly.Methods:A retrospective cohort of elderly patients (≥ 65 years) underwent acute abdominal surgery between 2008 and 2010 at the University of Alberta Hospital was analysed by abdominal CT scan at lumbar vertebra 3. CT scan was used to measure muscularity, visceral fat, and subcutaneous fat surface areas adjusted to the height (cm2/m2), and, their radiodensities measured in Hounsfield Units (HU). Logistic regression was used to assess the relationship between body composition and in-hospital mortality and postoperative complications. Age, sex, and American Society of Anesthesiologists (ASA) classification were incorporated in all models as covariates. The receiver area under curve (AUC) was used to test the predictive ability of the models.Results:A two-hundred fifteen patients were identified with a mean age of 77.3 ± 7.3. Multivariate analysis identified Skeletal Muscle Index (SMI) (adjusted odds ratio (aOR): 0.922, 95% CI: 0.863-0.985, p-value= 0.016) as a strong predictor of in-hospital mortality. Subcutaneous fat area radiodensity (SFA HU) (aOR: 1.028, 95% CI: 0.999-1.058, p-value= 0.055) showed a trend for association with in-hospital mortality. The best model including age, sex, ASA, SMI, and SFA HU had an AUC= 0.867. SMI (aOR: 0.977, 95% CI: 0.935-1.021, p-value= 0.307) and SFA (aOR: 1.013, 95% CI: 0.990-1.036, p-value= 0.272) were not significantly associated with major postoperative complications development (AUC= 0.755). Female sex (aOR: 0.455, 95% CI: 0.221-0.936, p-value= 0.032) and ASA score (aOR: 3.271, 95% CI: 2.026-5.279, p-value <0.001) were significantly associated with the risk of developing major complications.Conclusion:Sarcopenia was an independent predictor of in-hospital mortality. All body composition measurements were not associated with postoperative complications. Body composition measurements by CT scan can be used as a risk assessment tool, moreover, they represent a modifiable risk factor that can be targeted to improve the outcome perioperatively.

  • Subjects / Keywords
  • Graduation date
    Fall 2018
  • Type of Item
    Thesis
  • Degree
    Master of Science
  • DOI
    https://doi.org/10.7939/R3TT4G88B
  • License
    Permission is hereby granted to the University of Alberta Libraries to reproduce single copies of this thesis and to lend or sell such copies for private, scholarly or scientific research purposes only. Where the thesis is converted to, or otherwise made available in digital form, the University of Alberta will advise potential users of the thesis of these terms. The author reserves all other publication and other rights in association with the copyright in the thesis and, except as herein before provided, neither the thesis nor any substantial portion thereof may be printed or otherwise reproduced in any material form whatsoever without the author's prior written permission.