Sarcopenia predicts costs among patients undergoing major abdominal operations.
Although sarcopenia has been identified as a predictor of poor, postoperative, clinical outcomes, the financial impact of sarcopenia remains undetermined. We sought to evaluate the relationship between sarcopenia and hospital finances among a cohort of patients undergoing a hepato-pancreatico-biliary or colorectal resection.



Clinical, financial, and morphometric data were collected for 1,169 patients undergoing operative resection between January 2011 and December 2013 at the Johns Hopkins Hospital. Multivariable regression analysis was performed to assess the relationship between sarcopenia and total hospital costs.



Using sex-specific cutoffs for total psoas volume, 293 patients were categorized as sarcopenic. The presence of sarcopenia was associated with a $14,322 increase in the total hospital cost (median covariate-adjusted cost, sarcopenia versus no sarcopenia: $38,804 vs $24,482, P < .001). Patients who presented with sarcopenia demonstrated a higher total hospital cost within the subgroup of patients who developed a postoperative complication (sarcopenia versus no sarcopenia: $65,856 vs $59,609) and among those patients who did not develop a postoperative complication (sarcopenia versus no sarcopenia: $26,282 vs $23,763, both P < .001). Similarly, total hospital costs were higher among patients presenting with sarcopenia regardless of the length of stay for index admission (observed:expected, length of stay < 1: sarcopenia versus no sarcopenia: $25,038 vs $22,827; observed:expected, length of stay > 1: sarcopenia versus no sarcopenia: $43,283 vs $38,679, both P < .001).



As measured by sarcopenia, patient frailty is inversely related to total hospital costs. Sarcopenia represents a novel tool for forecasting patient outcomes and operative costs and can be used to inform quality improvement and cost containment strategies.
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
Faiz
F
Gani
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
Stefan
S
Buettner
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
Georgios A
GA
Margonis
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
Kazunari
K
Sasaki
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
Doris
D
Wagner
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
Yuhree
Y
Kim
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
John
J
Hundt
Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD.
Ihab R
IR
Kamel
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD. Electronic address: tpawlik1@jhmi.edu.
Timothy M
TM
Pawlik
D000368:Aged; D015331:Cohort Studies; D016208:Databases, Factual; D013505:Digestive System Surgical Procedures / Q000009:adverse effects / Q000191:economics* / Q000379:methods*; D005260:Female; D017721:Hospital Costs / Q000639:trends*; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000191:economics* / Q000503:physiopathology; D011237:Predictive Value of Tests; D012016:Reference Values; D012189:Retrospective Studies; D055948:Sarcopenia / Q000191:economics* / Q000601:surgery