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. 2020 Oct 1;155(10):942-949.
doi: 10.1001/jamasurg.2020.2497.

Association of Low Muscle Mass and Low Muscle Radiodensity With Morbidity and Mortality for Colon Cancer Surgery

Jingjie Xiao  1   2 , Bette J Caan  3 , Elizabeth M Cespedes Feliciano  3 , Jeffrey A Meyerhardt  4 , Peter D Peng  5 , Vickie E Baracos  6 , Valerie S Lee  3 , Sora Ely  7   8 , Rebecca C Gologorsky  7   8 , Erin Weltzien  3 , Candyce H Kroenke  3 , Marilyn L Kwan  3 , Stacey E Alexeeff  3 , Adrienne L Castillo  3 , Carla M Prado  2
Affiliations

Association of Low Muscle Mass and Low Muscle Radiodensity With Morbidity and Mortality for Colon Cancer Surgery

Jingjie Xiao et al. JAMA Surg. .

Erratum in

Abstract

Importance: Given the risks of postoperative morbidity and its consequent economic burden and impairment to patients undergoing colon resection, evaluating risk factors associated with complications will allow risk stratification and the targeting of supportive interventions. Evaluation of muscle characteristics is an emerging area for improving preoperative risk stratification.

Objective: To examine the associations of muscle characteristics with postoperative complications, length of hospital stay (LOS), readmission, and mortality in patients with colon cancer.

Design, setting, and participants: This population-based retrospective cohort study was conducted among 1630 patients who received a diagnosis of stage I to III colon cancer from January 2006 to December 2011 at Kaiser Permanente Northern California, an integrated health care system. Preliminary data analysis started in 2017. Because major complication data were collected between 2018 and 2019, the final analysis using the current cohort was conducted between 2019 and 2020.

Exposures: Low skeletal muscle index (SMI) and/or low skeletal muscle radiodensity (SMD) levels were assessed using preoperative computerized tomography images.

Main outcomes and measures: Length of stay, any complication (≥1 predefined complications) or major complications (Clavien-Dindo classification score ≥3), 30-day mortality and readmission up to 30 days postdischarge, and overall mortality.

Results: The mean (SD) age at diagnosis was 64.0 (11.3) years and 906 (55.6%) were women. Patients with low SMI or low SMD were more likely to remain hospitalized 7 days or longer after surgery (odds ratio [OR], 1.33; 95% CI, 1.05-1.68; OR, 1.39; 95% CI, 1.05-1.84, respectively) and had higher risks of overall mortality (hazard ratio, 1.40; 95% CI, 1.13-1.74; hazard ratio, 1.44; 95% CI, 1.12-1.85, respectively). Additionally, patients with low SMI were more likely to have 1 or more postsurgical complications (OR, 1.31; 95% CI, 1.04-1.65) and had higher risk of 30-day mortality (OR, 4.85; 95% CI, 1.23-19.15). Low SMD was associated with higher odds of having major complications (OR, 2.41; 95% CI, 1.44-4.04).

Conclusions and relevance: Low SMI and low SMD were associated with longer LOS, higher risk of postsurgical complications, and short-term and long-term mortality. Research should evaluate whether targeting potentially modifiable factors preoperatively, such as preserving muscle mass, could reverse the observed negative associations with postoperative outcomes.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Xiao reported grants from National Institutes of Health during the conduct of the study. Drs Caan, Cespedes Feliciano, Alexeeff, and Castillo reported grants from the National Cancer Institute during the conduct of the study. Dr Meyerhardt reported personal fees from COTA Healthcare and from Taiho Pharmaceutical outside the submitted work. Dr Prado reported personal fees from Abbott Nutrition and Nutricia and grants from the National Institutes of Health outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Mean Skeletal Mass Index (SMI) and Skeletal Muscle Radiodensity (SMD) by the Presence or Absence of Each Surgical Outcome
HU indicates Hounsfield unit; LOS, length of stay. aP < .05.
Figure 2.
Figure 2.. Areas Under the Receiver Operating Characteristic Curves for 30-Day Mortality
SMD indicates skeletal muscle radiodensity; SMI, skeletal muscle index.
See this image and copyright information in PMC

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