title: Sarcopenia is associated with postoperative infection and delayed recovery from colorectal cancer resection surgery.
abstract: BACKGROUND
  Skeletal muscle depletion (sarcopenia) predicts morbidity and mortality in the elderly and cancer patients.
  
  
  METHODS
  We tested whether sarcopenia predicts primary colorectal cancer resection outcomes in stage II-IV patients (n=234). Sarcopenia was assessed using preoperative computed tomography images. Administrative hospitalisation data encompassing the index surgical admission, direct transfers for inpatient rehabilitation care and hospital re-admissions within 30 days was searched for International Classification of Disease (ICD)-10 codes for postoperative infections and inpatient rehabilitation care and used to calculate length of stay (LOS).
  
  
  RESULTS
  Overall, 38.9% were sarcopenic; 16.7% had an infection and 9.0% had inpatient rehabilitation care. Length of stay was longer for sarcopenic patients overall (15.9 ± 14.2 days vs 12.3 ± 9.8 days, P=0.038) and especially in those ≥ 65 years (20.2 ± 16.9 days vs 13.1 ± 8.3 days, P=0.008). Infection risk was greater for sarcopenic patients overall (23.7% vs 12.5%; P=0.025), and especially those ≥ 65 years (29.6% vs 8.8%, P=0.005). Most (90%) inpatient rehabilitation care was in patients ≥ 65 years. Inpatient rehabilitation was more common in sarcopenic patients overall (14.3% vs 5.6%; P=0.024) and those ≥ 65 years (24.1% vs 10.7%, P=0.06). In a multivariate model in patients ≥ 65 years, sarcopenia was an independent predictor of both infection (odds ratio (OR) 4.6, (95% confidence interval (CI) 1.5, 13.9) P<0.01) and rehabilitation care (OR 3.1 (95% CI 1.04, 9.4) P<0.04).
  
  
  CONCLUSIONS
  Sarcopenia predicts postoperative infections, inpatient rehabilitation care and consequently a longer LOS.
authors.affiliation: Division of Human Nutrition, Department of Agricultural, Food & Nutritional Science, University of Alberta, Edmonton, Canada.
authors.forename: J R
authors.initials: JR
authors.lastname: Lieffers
authors.forename: O F
authors.initials: OF
authors.lastname: Bathe
authors.forename: K
authors.initials: K
authors.lastname: Fassbender
authors.forename: M
authors.initials: M
authors.lastname: Winget
authors.forename: V E
authors.initials: VE
authors.lastname: Baracos
mesh_terms: D000328:Adult; D000368:Aged; D002170:Canada / Q000453:epidemiology; D003082:Colectomy / Q000009:adverse effects*; D015179:Colorectal Neoplasms / Q000401:mortality / Q000473:pathology / Q000534:rehabilitation* / Q000601:surgery*; D015897:Comorbidity; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D016017:Odds Ratio; D010359:Patient Readmission; D011183:Postoperative Complications / Q000209:etiology* / Q000534:rehabilitation; D011237:Predictive Value of Tests; D012307:Risk Factors; D055948:Sarcopenia / Q000150:complications* / Q000209:etiology / Q000534:rehabilitation; D013530:Surgical Wound Infection / Q000209:etiology* / Q000534:rehabilitation; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed