| Introduction:Sarcopenia is a clinical syndrome characterized by progressive loss of muscle strength and muscle mass.Sarcopenia was believed to be associated with higher risk of postoperative complications,longer hospital stays,decreased quality of life and worse long-term prognosis.The variation of muscle mass and quality may reflect patients,inflammation and nutritional status as well as functional reserve.While post-induction blood pressure is greatly influenced by cardiovascular and neurohumor regulation,little has been studied in terms of the association between muscle status and post-induction hypotension(PIH).As sarcopenia study has just begun in China,the diagnosis criteria still need to be specified.This research aims to explore the epidemiology of sarcopenia in Chinese gynecologic tumor patients and the association of pre-operative skeletal muscle status and PIH as well as other perioperative adverse events.Methods:This study is a retrospective cohort study.Gynecological tumor patients who underwent major surgery during March 2015 to May 2018 and who met the inclusion criteria were examined.Pre-operative CT scans done within three months before surgery were analyzed at the third lumbar level for cross-section area and attenuation.Skeletal muscle index<39cm2/m2 was used as a cutoff value for muscle mass reduction,and HU AC<25 percentile(28.60HU)was used as a cutoff for myosteatosis.Post-induction hypotension defined as a decrease of more than 30%of baseline mean arterial pressure within 20 minutes after induction was considered as the primary outcome.Postoperative complications based on Clavien-Dindo classification within 30 days after surgery were considered as secondary outcome.Multiple logistic analysis and linear regression were used to analyze the association between muscle indexes and perioperative adverse events.Results:(1)A total of 166 patients were included in the final analysis.87(52.4%)patients were diagnosed as muscle mass reduction,41(24.7%)patients were diagnosed as myosteatosis.(2)56(33.7%)patients experienced post-operative induction hypotension.Myosteatosis was a risk factor for PIH(OR 2.93,95%CI:1.17-7.35,P=0.022)after adjusting age,history of diabetes,hypertension and coronary artery diseases,history of chemotherapy and radiotherapy,ASA grading,body mass index,prognostic nutrition index and preoperative mean arterial pressure.A higher incidence of PIH was observed in patients with muscle mass reduction(OR 1.29,95%CI:0.56-2.96,P=0.549)however,the difference was not significant.(3)87(52.4%)patients experienced postoperative complications of various degrees.Neither muscle mass reduction(OR 1.27,95%CI:0.60-2.67,P=0.530)nor myosteatosis(OR 0.89,95%CI:0.37-2.16,P=0.802)was a significant risk factor for postoperative complications within 30-days after surgery.Longer hospital stay was observed in patients with muscle mass reduction(mean difference=3.6days,95%CI:-2.6～9.9,P=0.254)and myosteatosis(mean difference=3.6days,95%CI:-3.8～11.0,P=0.342),nevertheless they were not significant The association between muscle indexes and postoperative recovery was undetermined in this pohort.Conclusions:The prevalence of muscle mass reduction and myosteatosis is relatively high among tumor patients undergoing major gynecological surgery.Myosteatosis is a risk factor for post-induction hypotension,while muscle mass reduction might not be a favorable predictor for PIH.Neither muscle mass reduction nor myosteatosis is an appropriate predictor for postoperative complications or postoperative recovery,further study in larger cohort is needed to elucidate the association between the above indexes and outcomes.Muscle analysis based on preoperative CT scan might help identification of high-risk patients and improvement of perioperative management. |
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