Comparison of surgical complications after curative surgery in patients with oral cavity squamous cell carcinoma and sarcopenia
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Abstract Background The study aims to clarify the association of sarcopenia with perioperative and postoperative complications in oral cavity squamous cell carcinoma (OCSCC) patients undergoing curative surgery and to understand the reasons causing the poor oncologic outcomes for OCSCC. Methods We conducted a propensity score matching study to investigate the association of perioperative and postoperative outcomes in OCSCC patients with sarcopenia and without sarcopenia. A retrospective analysis of a large national data set from the Taiwan Cancer Registry Database was conducted. At least two claims for patients with a principal diagnosis of sarcopenia within the 12‐month preoperative period were defined as the criteria for sarcopenia diagnosis (ICD‐10‐CM code M62.84). Sarcopenia was diagnosed through the measurement of low muscle strength and low muscle mass by any one of the patient's attending orthopaedic physician, rehabilitation physician, family medicine specialist or geriatrician. A multivariate logistic regression model was used to calculate the perioperative, and postoperative major complications. Results Our final cohort included 16 293 patients with OCSCC (10 862 and 5 431 in the sarcopenia and nonsarcopenia groups, respectively) who were eligible for further analysis. The sarcopenia group was 10.40% female and 89.60% male, and the nonsarcopenia group was 9.74% female and 90.26% male. The mean age ± standard deviation ( SD ) were 56.44 ± 11.14 and 56.22 ± 11.29 for sarcopenia and nonsarcopenia groups. OCSCC patients with sarcopenia undergoing curative surgery had a significantly higher blood transfusion rate and volume; longer intensive care unit (ICU) stay, and hospital stay; higher postoperative 30‐day mortality (adjusted odds ratio [aOR]: 1.12, 95% confidence interval [CI] [1.07, 1.56]) and rates of pneumonia (aOR: 1.34, 95% CI [1.20, 1.50]), acute renal failure (aOR: 1.45, 95% CI [1.12, 1.87]) and septicaemia (aOR: 1.29, 95% CI [1.15, 1.45]); higher postoperative first‐year mortality (aOR: 1.18, 95% CI [1.13, 1.51]) and rates of pneumonia (aOR: 1.43, 95% CI [1.30, 1.56]), acute myocardial infarction (aOR: 1.52, 95% CI [1.06, 2.18]) and septicaemia (aOR: 1.29, 95% CI [1.15, 1.45]). Conclusions OCSCC patients with sarcopenia might exhibit more perioperative and surgical complications than those without sarcopenia.Surgical oncology
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Background: Early detection and prevention of sarcopenia are essential for maintaining the functional health of older adults. There is a close association between sarcopenia and physical activity levels. Possible sarcopenia is a precursor to sarcopenia, which can accurately predict sarcopenia
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This study aimed to describe the frequency of sarcopenia and verify the agreement between instruments for diagnosis. This a cross-sectional study, where we used the algorithm proposed by the European Consensus Sarcopenia (EWGSOP), calf circumference (CC), muscle mass and body mass index. 167 elderly were evaluated with a mean age of 68.03 ± 6.12 years. The elderly frequency diagnosed by EWGSOP sarcopenia and CC was as follows: 40 (24.0%) and 15 (9.0%). A low degree of agreement between CC and the EWGSOP (P = 0.101) was found. However, these instruments due to the low financial cost and easy applicability are important auxiliary tools for the screening and diagnosis of sarcopenia in elderly.
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Sarcopenia is one of geriatric syndromes, characterized by decreased muscle mass accompanied by decreased muscle strength and/or performance. It is more prevalent with increase in age, and the prevalence depends on the criteria applied and the characteristic of the elderly. Sarcopenia has a higher risk of morbidity and mortality in elderly patients. The definition criteria of sarcopenia are still controversial, but diagnostic criteria from the Asian Working Group for Sarcopenia and the European Working Group on Sarcopenia in Older People (EWGSOP) are the most used criteria for clinical practice. Pathogenesis sarcopenia involved a multifactorial process and is divided into intrinsic and extrinsic factors. Risk factors for sarcopenia include constitutional factors, aging, lifestyle, changes in body condition, and chronic diseases. Based on that, sarcopenia is divided into primary and secondary sarcopenia. There are three stage of sarcopenia, which are pre-sarcopenia, sarcopenia, and severe sarcopenia. Nutrition and exercise are the two main pillars to manage sarcopenia.
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Sarcopenia is a syndrome characterized by progressive and generalized loss of skeletal muscle mass and strength. It is the major pathway leading to physical frailty, an important geriatric syndrome and an important problem in the elderly population. There are multiple factors leading to sarcopenia and frailty and for preventing them is important to determine the biochemical factors involved. We conducted a study on 143 elderly patients hospitalized during a nine months period. Demographic data were collected and biochemical parameters were determined. Sarcopenia was determined through muscle mass and muscle strength. The average age of the persons included in the study was 77.13 ± 6.30 years, without differences between gender distributions. To assess the relationship between the biochemical parameters and the presence of sarcopenia, the patients were divided into two groups: the group with sarcopenia and the group without sarcopenia. The analysis of the relationships between the presence of sarcopenia and the biochemical parameters determined within the study group, revealed that sarcopenia is correlated with blood glucose (p = 0.002, r = - 0.266), creatinine (p=0.010, r= -0.221) and also creatinine clearance (p=0.017, r=0.207). Biochemical determinations are important in determining sarcopenia and frailty and are of high importance before establishing any measure of treatment or prevention.
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Background: Early detection and prevention of sarcopenia arecritical. There is a close association between sarcopenia and physical activity levels. Possible sarcopenia is a precursor to sarcopenia, which can accurately predict sarcopenia. According to the tertiary prevention system, the diagnosis of possible sarcopenia has significant implications for the early detection of sarcopenia and the reduction of its prevalence.
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Sarcopenia can be classified as age-, activity-, nutrition-, and disease-related. Hospital-associated sarcopenia, acute sarcopenia, and iatrogenic sarcopenia are activity-, nutrition-, and disease-related, not age-related. There is considerable overlap between hospital-associated sarcopenia and acute sarcopenia; however, they are distinct concepts. Some causes of hospital-associated sarcopenia and acute sarcopenia are iatrogenic. Sarcopenia is important in primary care because it is a loss of skeletal muscle mass and function that causes bedridden, dysphagia, and respiratory dysfunction. However, the percentage of primary care physicians who are familiar with sarcopenia is quite low at 18.8%.1 The causes of sarcopenia can be classified into age, activity, nutrition, and disease. Therefore, sarcopenia can occur in people who are not old due to activity, nutrition, or disease. Sarcopenia often occurs during hospitalization in acute care hospitals. Hospital-associated sarcopenia refers to sarcopenia resulting from hospitalization and is related to hospital-associated deconditioning and hospital-associated disability. Hospital-associated sarcopenia occurs not only in acute care hospitals but also in rehabilitation and long-term care hospitals. Acute sarcopenia refers to sarcopenia that occurs primarily during an acute hospitalization.2 However, acute sarcopenia can occur in institutional and home medical care. Hospital-associated sarcopenia and acute sarcopenia are distinct concepts, although there is considerable overlap. The causes of hospital-associated sarcopenia and acute sarcopenia are activity, nutrition, and disease, not age. In addition, the causes of hospital-associated sarcopenia and acute sarcopenia are classified into non-iatrogenic and iatrogenic (Figure 1). Iatrogenic sarcopenia refers to sarcopenia caused by the activities of medical staff including doctors, nurses, or other healthcare professionals in healthcare facilities.3 Activity-related sarcopenia occurs in bed rest required for medical treatment. For example, if the patient is hemodynamically unstable and sitting causes arrhythmias and dyspnea, bed rest is required. Nutrition-related sarcopenia occurs when the patient's food intake is inadequate despite medically appropriate nutritional care management. Disease-related sarcopenia occurs with trauma, fractures, cancer, chronic organ failure, and chronic inflammatory diseases and medically necessary surgery. Activity-related sarcopenia occurs during medically unnecessary bed rest. For example, when the patient is hospitalized for aspiration pneumonia, the physician orders tentative bed rest without appropriate assessment. Nutrition-related sarcopenia results from medically inappropriate nutritional care management. For example, nutritional care management is often inadequate in hospitalized patients with aspiration pneumonia who do not take oral nutrition. Disease-related sarcopenia occurs with iatrogenic diseases or drug-related adverse events. Rehabilitation nutrition4 and rehabilitation pharmacotherapy5 can be useful in the prevention of hospital-associated sarcopenia and acute sarcopenia, both non-iatrogenic and iatrogenic. Rehabilitation nutrition and rehabilitation pharmacotherapy are defined as helping people with disabilities and frail older people to achieve the highest possible body functions, activities, participation, and quality of life (QOL), using holistic evaluation by the International Classification of Functioning, Disability and Health (ICF), rehabilitation nutrition care process, and rehabilitation pharmacotherapy management. The combination of rehabilitation, appropriate nutritional care management, and medication review from the day of admission can prevent sarcopenia during hospitalization to some extent. Prevention of iatrogenic sarcopenia is possible and should be done at all costs. However, prevention of sarcopenia due to non-iatrogenic disease is difficult. Primary care physicians working in acute care hospitals should be responsible for managing not only diseases causing hospitalization but also hospital-associated sarcopenia and acute sarcopenia and should provide rehabilitation nutrition and rehabilitation pharmacotherapy. Clinical practice guidelines for sarcopenia and rehabilitation nutrition are available for primary care physicians. The Global Leadership Initiative in Sarcopenia (GLIS) will develop new consensus papers for sarcopenia.6 For prevention of sarcopenia, it is desirable to include hospital-associated sarcopenia and acute sarcopenia, as well as age-related sarcopenia in the GLIS. The author has stated explicitly that there are no conflicts of interest in connection with this article.
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