Sarcopenia discriminates poor prognosis in elderly patients following emergency surgery for perforation panperitonitis

Aim: Sarcopenia has been reported as a prognostic predictor in various conditions; however, it has not been examined in patients with perforation panperitonitis. Methods: A total of 103 consecutive patients with perforation panperitonitis who underwent emergency surgery from 2008 to 2016 were retrospectively evaluated. Skeletal muscle index (SMI) was measured as the cross-sectional area (cm²) of skeletal muscle in the L3 region on computed tomography images normalized for height (cm²/m²). Sarcopenia was defined as an SMI of ≤43.75 and ≤41.10 cm²/m² in men and women, respectively. The impact of sarcopenia on postoperative outcomes was investigated. Results: Sarcopenia was present in 50 (48.5%) patients. Severe complications (Clavien-Dindo grade ≥IIIb) and in-hospital mortality were more frequently observed in patients with than without sarcopenia (28.0% vs 9.4%, P =.015) (20.0% vs 5.7%, P =.029) respectively. Multivariate analysis showed that age, sarcopenia, and renal dysfunction were independent risk factors for severe complications and in-hospital mortality. The optimal cut-off levels of age and SMI for predicting these were ≥79 years and SMI <38 cm²/m², respectively. Among the patients aged ≥79 years, those with SMI <38 cm²/m² had a severe complication rate of 71% and an in-hospital mortality rate of 57%, whereas the rate of those with SMI ≥38 cm²/m² was 22% (P =.011) and 11% (P =.008), respectively. Conclusion: Sarcopenia is a predictive factor of severe complications and in-hospital mortality following emergency surgery for perforation panperitonitis, especially in elderly patients. Estimation of sarcopenia may identify patients eligible or not eligible for emergency surgery among elderly patients.