Acute Sarcopenia after Elective and Emergency Surgery

Abstract

Sarcopenia is an increasingly recognised condition of loss of muscle mass and function. The European Working Group on Sarcopenia in Older People 2 (EWSOP2) updated their definition in 2018, emphasising the importance of low muscle strength in diagnosis. Acute sarcopenia has been arbitrarily defined as sarcopenia lasting less than 6 months. This review highlights the pathophysiology involved in muscle wasting following surgery, focussing on hormonal factors, inflammation, microRNAs, and oxidative stress. Biomarkers such as GDF-15, IGF-1 and various microRNAs may predict post-surgical muscle loss. The impact of existing sarcopenia on various types of surgery and incident muscle wasting following surgery is also described. The gaps in research found include the need for longitudinal studies looking in changes in muscle strength and quantity following surgery. Further work is needed to examine if biomarkers are replicated in other surgery to consolidate existing theories on the pathophysiology of muscle wasting.

Keywords: acute sarcopenia; biomarkers; muscle wasting; surgery.

Figure 1.

schematic demonstrating the key components in sarcopenia pathophysiology. The factors and pathways involved in the balance between proteolysis (leading to sarcopenia) and anabolism is shown. Blue line indicates activation of a pathway and red line indicates inhibition of a pathway.

Figure 2.

risk factors and causes of muscle wasting in the surgical patient.