according to findings from a prospective, single-institution study.
Steve R. Siegal, MD, and his colleagues at the Oregon Health & Science University, Portland, wrote inthat risk factors for postoperative complications after hernia repair established in the literature include uncontrolled diabetes, active tobacco use, prior hernia repair, active infection, and obesity. Sarcopenia occurs in many physiological or pathological states, not only in the elderly but also in cases of immunosuppression, cirrhosis, trauma, prolonged immobility, and malignancy. Many opportunities exist for sarcopenia and hernia surgery to coincide but the role of sarcopenia in hernia repair outcomes has not been much studied.
The investigators began with the hypothesis that sarcopenia in hernia patients would lead to worse postoperative outcomes given the large metabolic requirement for postoperative healing of hernia defects and abdominal wall reconstruction.
The study involved 135 patients who underwent ventral hernia repair, 27% of whom had sarcopenia. The literature-based definition of sarcopenia was a muscle index cutoff of less than 52.4 cm2/m2 for men and less than 38.5 cm2/m2 for women. The investigators noted that the index cutoff was validated in oncology patients. Patients underwent a preoperative CT scan to assess muscle mass. The study group included patients with ventral hernia repair with or without mesh, component separation/abdominal wall reconstruction, and a hernia defect of 2 cm or larger.
With data on variables including gender, diabetes status, body mass index (BMI), chronic obstructive pulmonary disease (COPD), wound class, alcohol abuse status, and prior wound infections, the investigators created a multivariate model to look at primary outcomes of surgical site infection (SSI), surgical site occurrences (wound complications, other infections) and hernia recurrence. Secondary outcomes included length of hospital stay, morbidities, and other postoperative complications.
Patients with sarcopenia were more likely to have lower BMI (median 29.6 kg/m2 vs. 36.6 kg/m2), to be slightly older (median 63.1 vs. 59.2 years), and to have a history of immunosuppression (29.7% vs. 11.2%). The differences for the other variables (diabetes, tobacco use, COPD) were not significant.
The surprising finding was that sarcopenia was not significantly correlated with SSIs (P = 0.140), other complications (P = 0.113), or recurrence (P = 0.895) after ventral hernia repair. In-hospital morbidities and length of hospital stay did not differ significantly between the sarcopenic and nonsarcopenic patients. But sarcopenia combined with other factors did have an impact on outcomes. After adjustment for BMI and diabetes and critical care status, muscle mass as a continuous variable “was notable for a 1.44 increased odds [95% confidence interval, 1.00-2.07; P = 0.049] of inpatient morbidity with every decrease of 10 cm2/m2 of muscle index,” Dr. Siegal and his associates wrote.