title: Functional compromise reflected by sarcopenia, frailty, and nutritional depletion predicts adverse postoperative outcome after colorectal cancer surgery.
abstract: OBJECTIVE
  To determine the association of sarcopenia with postoperative morbidity and mortality after colorectal surgery.
  
  
  BACKGROUND
  Functional compromise in elderly colorectal surgical patients is considered as a significant factor of impaired postoperative recovery. Therefore, the predictive value of preoperative functional compromise assessment was investigated. Sarcopenia is a hallmark of functional compromise.
  
  
  METHODS
  A total of 310 consecutive patients who underwent oncologic colorectal surgery were included in a prospective digital database. Sarcopenia was assessed using the L3 muscle index utilizing Osirix on preoperative computed tomography. Groningen Frailty Indicator and Short Nutritional Assessment Questionnaire scores were used to assess frailty and nutritional compromise. Predictors for anastomotic leakage, sepsis, and mortality were analyzed by logistic regression analysis.
  
  
  RESULTS
  Age was an independent predictor of mortality [P = 0.04; odds ratio, 1.17; 95% confidence interval (CI), 1.01-1.37]. Thirty-day/in-hospital mortality rate in sarcopenic patients was 8.8% versus 0.7% in nonsarcopenic patients (P = 0.001; odds ratio, 15.5; 95% CI, 2.00-120). Sarcopenia was not predictive for anastomotic leakage or sepsis. Combination of high Short Nutritional Assessment Questionnaire score, high Groningen Frailty Indicator score, and sarcopenia strongly predicted sepsis (P = 0.001; odds ratio, 25.1; 95% CI, 5.11-123), sensitivity, 46%; specificity, 97%; positive likelihood ratio, 13 (95% CI, 4.4-38); negative likelihood ratio, 0.57 (95% CI, 0.33-0.97).
  
  
  CONCLUSIONS
  Functional compromise in colorectal cancer surgery is associated with adverse postoperative outcome. Assessment of functional compromise by means of a nutritional questionnaire (Short Nutritional Assessment Questionnaire), a frailty questionnaire (Groningen Frailty Indicator), and sarcopenia measurement (L3 muscle index) can accurately predict postoperative sepsis.
authors.affiliation: *Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands †NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University, Maastricht, The Netherlands ‡Department of Surgery, Orbis Medical Center, Sittard, The Netherlands; and §GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands.
authors.forename: Kostan W
authors.initials: KW
authors.lastname: Reisinger
authors.forename: Jeroen L A
authors.initials: JL
authors.lastname: van Vugt
authors.forename: Juul J W
authors.initials: JJ
authors.lastname: Tegels
authors.forename: Claire
authors.initials: C
authors.lastname: Snijders
authors.forename: Karel W E
authors.initials: KW
authors.lastname: Hulsewé
authors.forename: Anton G M
authors.initials: AG
authors.lastname: Hoofwijk
authors.forename: Jan H
authors.initials: JH
authors.lastname: Stoot
authors.forename: Maarten F
authors.initials: MF
authors.lastname: Von Meyenfeldt
authors.forename: Geerard L
authors.initials: GL
authors.lastname: Beets
authors.forename: Joep P M
authors.initials: JP
authors.lastname: Derikx
authors.forename: Martijn
authors.initials: M
authors.lastname: Poeze
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D057868:Anastomotic Leak / Q000453:epidemiology / Q000209:etiology; D015179:Colorectal Neoplasms / Q000601:surgery*; D005260:Female; D016330:Frail Elderly; D015577:Geriatric Assessment; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D044342:Malnutrition / Q000150:complications* / Q000175:diagnosis; D016017:Odds Ratio; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D055948:Sarcopenia / Q000150:complications* / Q000175:diagnosis; D018805:Sepsis / Q000453:epidemiology / Q000209:etiology; D011795:Surveys and Questionnaires; D016896:Treatment Outcome