Sarcopenia is associated with postoperative infection and delayed recovery from colorectal cancer resection surgery

Abstract

Background: Skeletal muscle depletion (sarcopenia) predicts morbidity and mortality in the elderly and cancer patients.

Methods: We tested whether sarcopenia predicts primary colorectal cancer resection outcomes in stage II-IV patients (n=234). Sarcopenia was assessed using preoperative computed tomography images. Administrative hospitalisation data encompassing the index surgical admission, direct transfers for inpatient rehabilitation care and hospital re-admissions within 30 days was searched for International Classification of Disease (ICD)-10 codes for postoperative infections and inpatient rehabilitation care and used to calculate length of stay (LOS).

Results: Overall, 38.9% were sarcopenic; 16.7% had an infection and 9.0% had inpatient rehabilitation care. Length of stay was longer for sarcopenic patients overall (15.9 ± 14.2 days vs 12.3 ± 9.8 days, P=0.038) and especially in those ≥ 65 years (20.2 ± 16.9 days vs 13.1 ± 8.3 days, P=0.008). Infection risk was greater for sarcopenic patients overall (23.7% vs 12.5%; P=0.025), and especially those ≥ 65 years (29.6% vs 8.8%, P=0.005). Most (90%) inpatient rehabilitation care was in patients ≥ 65 years. Inpatient rehabilitation was more common in sarcopenic patients overall (14.3% vs 5.6%; P=0.024) and those ≥ 65 years (24.1% vs 10.7%, P=0.06). In a multivariate model in patients ≥ 65 years, sarcopenia was an independent predictor of both infection (odds ratio (OR) 4.6, (95% confidence interval (CI) 1.5, 13.9) P<0.01) and rehabilitation care (OR 3.1 (95% CI 1.04, 9.4) P<0.04).

Conclusion: Sarcopenia predicts postoperative infections, inpatient rehabilitation care and consequently a longer LOS.

Figure 1

Scatterplots depicting the relationship between age and skeletal muscle index, and the incidence of (A) infection and (B) convalescent/rehabilitation care in patients undergoing primary colorectal cancer tumour resection. Solid circles (•) are patients who had the negative outcome (i.e., infection or convalescent care) and the hollow circles (○) are patients who did not have the outcome. Horizontal solid line- age 65 years. Vertical solid line—gender-specific sarcopenia cutpoints (Prado et al, 2008). Equation for each panel is the regression line of best fit.