S. Baker1, M. Waldrop1, J. Swords1, T. Wang1, M. J. Heslin1, C. M. Contreras1, S. Reddy1 1University Of Alabama at Birmingham,Surgical Oncology,Birmingham, Alabama, USA
Introduction: Estimating sarcopenia by measuring psoas muscle density (PMD) has been advocated as a method to accurately predict post-operative morbidity. This method is cumbersome and not feasible for a busy surgeon to use in practice. We have previously demonstrated that a simple timed stair climb (TSC) outperforms the ACS NSQIP Surgical Risk Calculator in predicting morbidity and hospital length of stay. The aim of the present study is to determine whether the TSC is a marker of axial muscle strength and can be used to replace PMD measurements in predicting morbidity.
Methods: From March 2014 to May 2015, 298 patients attempted TSC prior to undergoing elective abdominal surgery. PMD was measured using pre-operative CT scans obtained within 30 days of surgery at the L3 vertebra. Ninety-day complications were assessed using the Accordion Severity Grading System. Multivariable analysis was performed to identify pre-operative risk factors associated with operative morbidity.
Results: A grade 2 or higher complication occurred in 72 (24.2%) of patients with 8 (2.7%) deaths. There was an inverse relationship between PMD and TSC (Figure, P<0.0001) and a direct relationship between TSC and complications (Figure, P=0.04). On multivariable analysis only the decreasing PMD (P=0.018) and increasing TSC (P=0.026) were predictive of post-operative morbidity. Area under the receiver operating characteristic curves demonstrated no difference between TSC and PMD in predicting complications (AUC 0.72 vs. 0.70, P=0.49). Both TSC and PMD were superior to the ACS NSQIP Risk Calculator (AUC 0.55, both P<0.05).
Conclusions: Both TSC and PMD are excellent predictors of post-operative morbidity in this population. TSC appears to be a surrogate for axial muscle strength measured by PMD. TSC is an easy tool to administer in lieu of PMD when considering patient outcomes.
