The predictive value of computerized tomography-assessed sarcopenia for complicated appendicitis in geriatric patients

Abstract

Objective: Geriatric patients have more complicated appendicitis, which leads to higher morbidity and mortality rates. Sarcopenia has been shown to have a negative impact on patients undergoing surgery. This study aims to reveal the predictive value of computerized tomography-assessed (CT-assessed) sarcopenia for complicated appendicitis in geriatric patients.

Methods: One-hundred fifty-four patients' with acute appendicitis age, gender, co-morbidities, appendicitis status, and body mass index (BMI) values were analyzed. The skeletal muscle index (SMI) and related measurements were evaluated.

Results: Fifty-two percent of the patients had complicated, and 48% had uncomplicated appendicitis. There was a statistically significant difference between uncomplicated and complicated cases regarding BMI, SMI, and muscle area values (P < 0.05). The cutoff point by Receiver Operating Characteristic Curve analysis was conducted for SMI and showed 71% sensitivity and 52% specificity (P = 0.042). Multivariate analysis has shown that comorbidities are significantly more associated with complicated appendicitis than sarcopenia.

Conclusion: Geriatric patients with lower BMI, decreased muscle area, and CT-detected sarcopenia have an increased risk of complicated appendicitis. Comorbidities are also important risk factors. Surgeons should be aware of factors leading to complicated appendicitis, which may cause higher morbidity and mortality rates in elderly patients.

Keywords: appendicitis; geriatrics; perforated; sarcopenia.

FIGURE 1

Axial unenhanced CT scan at L3 vertebrae mid‐corpus level. (A) raw image; (B) all tissues segmented (single slice); (C) Mask images of segmentation, blue represents subcutaneous fatty tissue, red muscle tissue and yellow mesenteric fatty tissue; (D) Segments on raw CT image. CT, computed tomography.

FIGURE 2

Receiver operating characteristic curve analysis of the sarcopenia index (SMI cm²/m²), muscle area, and BMI for predicting complicated appendicitis. BMI, body mass index; ROC, receiver operating characteristic curve; SMI, skeletal muscle index.