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| Paradoxical relationship of muscle fibre cross-sectional area in older emergency surgery patients.Background: The number and cross sectional area (CSA) of individual fibers within a muscle determine the muscle's capacity to generate force, and both lessen with age. Muscle fibre area is normally positively associated with strength. A variety of indices of frailty and function are available for older patients, however the corresponding muscle morphology is limited.
Methods: Rectus abdominis (RA) muscle biopsies were collected during surgery from n=24 female patients 65-94 y of age undergoing emergency surgery. Frozen muscle samples were mounted in cross section and immunostained for muscle fiber area (µm2). Muscle cross sectional area (CSA; cm2) was calculated from CT images at lumbar 3 obtained from medical records of patients. Correlations were determined using IBM SPSS software.
Results: Mean RA muscle fibre cross sectional area was 3437 µm² (range 1452-6705 µm²), however this was not correlated with age (p=0.928), BMI (p=0.109) or frailty (p=0.540). Patients with larger muscle fibers performed more poorly in sit-to-stand tests (p=0.030) and had increased intramuscular adipose tissue (p=0.036).
Conclusions: Larger muscle fibre area is associated significantly with lower sit-to-stand performance. Further research is required to understand why larger muscle fibres in older adults are not associated with better strength and function.
CAT2014-31 University of Alberta | Specialized Publication | 2018-09-20 | | | The role of body composition in predicting outcomes in the elderly following acuteBackground:
As the elderly population are increasing, their need for emergency surgery is expected to rise.
With aging, there is a decrease in skeletal muscle mass and an increase in visceral fat. To date,
the role of age-associated changes in body composition with outcome is unclear. We aimed to
examine the association of body composition identified by computed tomography (CT) scan with
in-hospital mortality and postoperative complications.
Methods:
A retrospective cohort of 215 patients aged ≥ 65 years underwent acute abdominal surgery
between 2008 and 2010 at the University of Alberta Hospital was analysed. CT scan at L3 was
used to measure height-adjusted surface area (cm/m 2 ) of muscularity, visceral fat, and
subcutaneous fat, and, their radiodensities in Hounsfield Units (HU). Logistic regression was
used to assess the relationship between body composition and in-hospital mortality and
postoperative complications.
Results:
Multivariate analysis identified muscularity (aOR: 0.922, 95% CI: 0.863-0.985, p-value= 0.016)
was a strong predictor of in-hospital mortality while subcutaneous fat radiodensity was not
(aOR: 1.028, 95% CI: 0.999-1.058, p-value= 0.055). Muscularity (aOR: 0.977, 95% CI: 0.935-
1.021, p-value= 0.307) and subcutaneous fat radiodensity (aOR: 1.013, 95% CI: 0.990-1.036, p-
value= 0.272) were not significantly associated with postoperative complications.
Conclusion:
Muscularity was an independent predictor of in-hospital mortality. CT-identified body
composition measurements can be used for risk stratification and as a potential modifiable risk
factor for intervention.CAT2014-31 University of Alberta | Specialized Publication | 2018-09-20 | | | Ultrasound as a Point-of-Care Tool for Assessing Frailty and risk of Post-Operative Complications in Elderly Emergency Surgery PatientsBackground: Computed tomography (CT) scan quantifying skeletal muscle mass has been used as the gold standard tool to identify sarcopenia. Unfortunately, high cost, limited availability, and radiation exposure limit the use of CT. We propose that ultrasound of the thigh muscle as an objective, reproducible, portable, and risk free tool that can be used as a surrogate to the CT scan to help identify high risk patients.
Methods: We recruited 72 patients over 64 years old, referred to the Acute Care Surgery service. An ultrasound of thigh muscle thickness was standardized to patient thigh length (U/Swhole/L¬). CT skeletal muscle index (SMI) was calculated using skeletal muscle surface area of the L3 region divided by height2. Frailty status was assessed using the Rockwood Clinical Frailty Scale.
Results: Forty-nine of the 72 patients had a CT scan and ultrasound. The mean age was 76 + 8 years and 34% (n=17) were males. CT-defined sarcopenia was identified in 65% (n=11) of males and 75% (n=24) of females. In general, females had longer stay in hospital than males (14 + 9 vs. 7 + 3, P=0.003). There was a significant positive correlation between thigh U/Swhole/L and CT SMI. There was an inverse correlation between thigh U/Swhole/L and frailty score; a similar relationship was observed between CT SMI and frailty. U/Swhole/L but not CT SMI was also correlated to postoperative major complications.
Conclusion: Thigh U/Swhole/L index provides both an objective tool to assess for frailty and can assist in identifying older patients who are at high risk for developing post-operative complications.CAT2014-31 University of Alberta | Publication | 2016-07-29 | |
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