BACKGROUND This study aimed to investigate the associations of 2 preoperative muscle-related parameters, the third lumbar vertebra skeletal muscle index (L3 SMI) for muscle mass and the Hounsfield unit average calculation (HUAC) for muscle density, with the occurrence of postoperative complications among patients undergoing colorectal tumor resection surgery under general anesthesia. We hypothesized that muscle-related parameters are associated with the occurrence of postoperative complications. METHODS This was a single-center, retrospective observational study. Adult patients who underwent colorectal tumor resection surgery under general anesthesia between 2018.09.01 and 2021.09.01 were enrolled. The last abdominal computed tomography (CT) scan images obtained within 3 months before surgery were used to calculate the L3 SMI and HUAC. The primary outcome was defined as the occurrence of any postoperative complications corresponding to Clavien-Dindo classification before discharge. The secondary outcome was defined as the occurrence of any severe postoperative complications (Clavien-Dindo grade ≥3) before discharge. Multivariable logistic regression analyses were used to estimate the association between muscle-related parameters and incidence of postoperative complications. Patients' baseline demographics, past medical history and intraoperative parameters were adjusted in the multivariable logistic regression analysis. RESULTS A total of 317 patients with a median age of 66 (58-72) years were included. Sarcopenia (muscle mass reduction) patients in our cohort and myosteatosis (muscle density decline) were present in 254 (80.1 %) and 79 (24.9%) patients, respectively. A total of 135 patients (42.6 %) developed postoperative complications. According to the multivariable logistic regression, myosteatosis (odds ratio [OR], 1.8, 95% confidence interval [CI], 1.0-3.3, P = .039) was significantly associated with postoperative complications. CONCLUSIONS A significant association was observed between myosteatosis and postoperative complications (corresponding to Clavien-Dindo classification before discharge), especially severe postoperative complications (Clavien-Dindo grade ≥3) in patients undergoing colorectal tumor resection. Screening for myosteatosis with HUAC using the CT before surgery may help clinicians identify high-risk perioperative patients early.

中文翻译：

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结直肠肿瘤切除术患者两个肌肉相关参数与术后并发症之间的关联。


背景 本研究旨在探讨 2 个术前肌肉相关参数，即肌肉质量的第三腰椎骨骼肌指数 （L3 SMI） 和肌肉密度的 Hounsfield 单位平均计算 （HUAC） 与全身麻醉下接受结直肠肿瘤切除术的患者术后并发症发生的相关性。我们假设肌肉相关参数与术后并发症的发生有关。方法 这是一项单中心、回顾性观察性研究。纳入 2018.09.01 至 2021.09.01 期间在全身麻醉下行结直肠肿瘤切除手术的成年患者。采用手术前 3 个月内获得的最后一次腹部计算机断层扫描 （CT） 扫描图像计算 L3 SMI 和 HUAC。主要结局定义为出院前发生与 Clavien-Dindo 分类对应的任何术后并发症。次要结局定义为出院前发生任何严重的术后并发症 （Clavien-Dindo ≥3 级）。采用多变量 logistic 回归分析估计肌肉相关参数与术后并发症发生率之间的相关性。在多变量 logistic 回归分析中调整患者的基线人口统计学、既往病史和术中参数。结果 共纳入 317 例患者，中位年龄为 66 （58-72） 岁。我们队列中的肌肉减少症 （肌肉质量减少） 患者和肌脂肪变性 （肌肉密度下降） 分别见于 254 例 （80.1%） 和 79 例 （24.9%） 患者。共有 135 例患者 （42.6%） 出现术后并发症。 根据多变量 logistic 回归，肌脂肪变性 （比值比 [OR]，1.8,95% 置信区间 [CI]，1.0-3.3，P = .039）与术后并发症显著相关。结论 肌脂肪变性与术后并发症 （对应于出院前 Clavien-Dindo 分类） 之间存在显著相关性，尤其是接受结直肠肿瘤切除术的患者严重术后并发症 （Clavien-Dindo ≥3 级）。术前使用 CT 使用 HUAC 筛查肌脂肪变性可能有助于临床医生及早识别高危围手术期患者。