Abstract
Background: Functional compromise contributes significantly to adverse outcomes after emergency laparotomy. Sarcopenia, defined as reduced muscle strength and muscle quantity, has been seldom assessed in patients undergoing emergency laparotomy. The aim of this study was to examine functional compromise in emergency laparotomy using sarcopenia, myosteatosis, and frailty parameters and evaluate impacts on functional and patient-centred outcomes.
Methods: Patients aged greater than or equal to 55 years who underwent emergency laparotomy and preoperative computed tomography (CT) at two hospitals in New Zealand between February 2022 and October 2023 were included in a prospective database. Sarcopenia was measured using the SARC-F questionnaire, isokinetic dynamometry to measure hand grip strength, and skeletal muscle quantity according to CT. Myosteatosis was determined using CT and frailty was assessed using the Clinical Frailty Scale. Predictors for rehabilitation, days alive and out of hospital at 90 days, and risk of not returning home were analysed using relative risk and proportional means regression. Secondary outcomes were 3- and 6-month mortality and inpatient morbidity defined using the Clavien-Dindo classification.
Results: A total of 101 patients undergoing emergency laparotomy during the study interval were analysed; 21.6% of participants had sarcopenia, 34.7% had myosteatosis, and 24.8% were living with frailty. Muscle strength parameters (low grip strength and a positive SARC-F questionnaire) had significant relationships with primary outcomes. Low grip strength (less than 27 kg for male patients and less than 16 kg for female patients) was most significant for risk of admission for rehabilitation (adjusted risk ratio 5.48 (95% c.i. 2.03 to 14.82)). A positive SARC-F questionnaire (an overall score of greater than or equal to 4 out of 10) was most significant for not returning home (adjusted risk ratio 8.26 (95% c.i. 1.81 to 37.76)). Isolated low muscle quantity (less than 52.4 cm2/m2 for male patients and less than 38.5 cm2/m2 for female patients) demonstrated no relationship. Being frail was most significant for a reduced number of days alive and out of hospital at 90 days (-13.4% compared with non-frail participants (95% c.i. -24.3% to -0.8%)). Sarcopenia and low grip strength were the only parameters to demonstrate a relationship with 3- and 6-month mortality.
Conclusion: Sarcopenia and frailty parameters are major determinants of functional compromise and predict adverse outcomes after emergency laparotomy. Muscle strength is more important than mass, and measurable without imaging, streamlining its clinical application.