Meta-analysis of the effect of sarcopenia in predicting postoperative mortality in emergency and elective abdominal surgery

Abstract

Objectives: To investigate the effect of sarcopenia on postoperative mortality in patients undergoing emergency abdominal procedures and to compare postoperative mortality in patients with sarcopenia undergoing emergency abdominal procedures with those undergoing elective abdominal procedures.

Methods: A search of electronic information sources was conducted to identify all observational studies comparing sarcopenia with no sarcopenia in a) emergency abdominal surgery and b) elective abdominal surgery. We also identified the available cohort of patients in the literature with sarcopenia undergoing abdominal procedures and divided the entire cohort into two groups based on exposure to emergency surgery or elective surgery. The primary outcome measure of this study was postoperative 30-day mortality.

Results: Overall, 4 studies, enrolling a total of 734 patients, were eligible for the comparison in emergency setting and 16 studies, enrolling a total of 4590 patients, were eligible for the comparison in elective setting. Sarcopenia is associated with significantly higher risk of 30-day mortality (RR: 2.15, P < 0.0001), 1-year mortality (RR:1.97, P < 0.0001), total complications (RR:2.07, P = 0.0008), and need for ICU admission (RR:1.38, P = 0.003) and significantly longer length of ICU stay (MD:2.26, P = 0.006) and length of hospital stay (MD:2.46, P < 0.00001) compared to no sarcopenia in patients undergoing emergency abdominal procedures. Sarcopenia was also associated with significantly higher risk of 30-day mortality in patients undergoing elective abdominal procedures (RR:2.15, P = 0.002). Emergency abdominal surgery in patients with sarcopenia was associated with significantly higher risk of 30-day mortality compared to elective surgery (OR:12.00, P < 0.00001).

Conclusions: Sarcopenia is an independent predictor of postoperative mortality in emergency abdominal surgery.

Keywords: Elective surgical procedure; General surgery; Laparotomy; Sarcopenia.