Skip to main content

Advertisement

SpringerLink
Log in

Impact of sarcopenia on surgical site infection after restorative proctocolectomy for ulcerative colitis

  • Original Article
  • Published:
Surgery Today Aims and scope Submit manuscript

Abstract

Purpose

The coexistence of sarcopenia is associated with postoperative complications, including infection after abdominal surgery. We evaluated the association between sarcopenia and surgical site infection (SSI) after surgery for ulcerative colitis.

Methods

The subjects of this retrospective study were 69 patients who underwent restorative proctocolectomy with perioperative abdominal computed tomography (CT). Sarcopenia was diagnosed by measuring the cross-sectional area of the right and left psoas muscles as the total psoas muscle area on CT images. We assessed whether sarcopenia was associated with SSI and clinical factors, including nutritional and inflammatory markers.

Results

The lowest quartiles defined as sarcopenia in men and women were 567.4 and 355.8 mm2/m2, respectively. According to this classification, 12 men and 6 women had sarcopenia. Patients with sarcopenia had a lower body mass index (p = 0.0004) and a higher C-reactive protein concentration (p = 0.05) than those without sarcopenia. SSIs were identified in 12 patients (17.3 %) and included six pelvic abscesses and seven wound infections. According to multivariate analysis, sarcopenia was an independent risk factor for SSI (odds ratio = 4.91, 95 % confidence interval 1.09–23.5, p = 0.03).

Conclusion

Sarcopenia is predictive of SSI after pouch surgery for ulcerative colitis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Okita Y, Araki T, Kawamura M, Kondo S, Inoue M, Kobayashi M, et al. Clinical features and management of afferent limb syndrome after ileal pouch-anal anastomosis for ulcerative colitis. Surg Today. 2016. doi:10.1007/s00595-016-1307-7.

  2. Miki C, Ohmori Y, Yoshiyama S, Toiyama Y, Araki T, Uchida K, et al. Factors predicting postoperative infectious complications and early induction of inflammatory mediators in ulcerative colitis patients. World J Surg. 2007;31:522–9 (discussion 30–1).

    Article  PubMed  Google Scholar 

  3. Kimura H, Takahashi K, Futami K, Ikeuchi H, Tatsumi K, Watanabe K, et al. Has widespread use of biologic and immunosuppressant therapy for ulcerative colitis affected surgical trends? Results of a questionnaire survey of surgical institutions in Japan. Surg Today. 2015. doi:10.1007/s00595-015-1259-3.

  4. Delgado-Rodriguez M, Gomez-Ortega A, Llorca J, Lecuona M, Dierssen T, Sillero-Arenas M, et al. Nosocomial infection, indices of intrinsic infection risk, and in-hospital mortality in general surgery. J Hosp Infect. 1999;41:203–11.

    Article  CAS  PubMed  Google Scholar 

  5. Astagneau P, Rioux C, Golliot F, Brucker G, Group INS. Morbidity and mortality associated with surgical site infections: results from the 1997–1999 INCISO surveillance. J Hosp Infect. 2001;48:267–74.

    Article  CAS  PubMed  Google Scholar 

  6. Kobayashi M, Mohri Y, Tonouchi H, Miki C, Nakai K, Kusunoki M, et al. Randomized clinical trial comparing intravenous antimicrobial prophylaxis alone with oral and intravenous antimicrobial prophylaxis for the prevention of a surgical site infection in colorectal cancer surgery. Surg Today. 2007;37:383–8.

    Article  CAS  PubMed  Google Scholar 

  7. Pendlimari R, Cima RR, Wolff BG, Pemberton JH, Huebner M. Diagnoses influence surgical site infections (SSI) in colorectal surgery: a must consideration for SSI reporting programs? J Am Coll Surg. 2012;214:574–80 (discussion 80–1).

    Article  PubMed  Google Scholar 

  8. Araki T, Okita Y, Uchino M, Ikeuchi H, Sasaki I, Funayama Y, et al. Risk factors for surgical site infection in Japanese patients with ulcerative colitis: a multicenter prospective study. Surg Today. 2014;44:1072–8.

    Article  PubMed  Google Scholar 

  9. Kirkland KB, Briggs JP, Trivette SL, Wilkinson WE, Sexton DJ. The impact of surgical-site infections in the 1990s: attributable mortality, excess length of hospitalization, and extra costs. Infect Control Hosp Epidemiol. 1999;20:725–30.

    Article  CAS  PubMed  Google Scholar 

  10. Sagar PM, Pemberton JH. Intraoperative, postoperative and reoperative problems with ileoanal pouches. Br J Surg. 2012;99:454–68.

    Article  CAS  PubMed  Google Scholar 

  11. Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR. Guideline for Prevention of Surgical Site Infection, 1999. Centers for disease control and prevention (CDC) Hospital Infection Control Practices Advisory Committee. Am J Infect Control. 1999;1999(27):97–132 (quiz 3–4, discussion 96).

    Article  Google Scholar 

  12. Kirchhoff P, Clavien PA, Hahnloser D. Complications in colorectal surgery: risk factors and preventive strategies. Patient Saf Surg. 2010;4:5.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Cruz-Jentoft AJ, Baeyens JP, Bauer JM, Boirie Y, Cederholm T, Landi F, et al. Sarcopenia: European consensus on definition and diagnosis: report of the European Working Group on sarcopenia in older people. Age Ageing. 2010;39:412–23.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Rosenberg IH, Roubenoff R. Stalking sarcopenia. Ann Intern Med. 1995;123:727–8.

    Article  CAS  PubMed  Google Scholar 

  15. Kim TN, Choi KM. Sarcopenia: definition, epidemiology, and pathophysiology. J Bone Metab. 2013;20:1–10.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Janssen I, Heymsfield SB, Ross R. Low relative skeletal muscle mass (sarcopenia) in older persons is associated with functional impairment and physical disability. J Am Geriatr Soc. 2002;50:889–96.

    Article  PubMed  Google Scholar 

  17. Awad S, Tan BH, Cui H, Bhalla A, Fearon KC, Parsons SL, et al. Marked changes in body composition following neoadjuvant chemotherapy for oesophagogastric cancer. Clin Nutr. 2012;31:74–7.

    Article  PubMed  Google Scholar 

  18. Prado CM, Baracos VE, McCargar LJ, Reiman T, Mourtzakis M, Tonkin K, et al. Sarcopenia as a determinant of chemotherapy toxicity and time to tumor progression in metastatic breast cancer patients receiving capecitabine treatment. Clin Cancer Res. 2009;15:2920–6.

    Article  CAS  PubMed  Google Scholar 

  19. Huillard O, Mir O, Peyromaure M, Tlemsani C, Giroux J, Boudou-Rouquette P, et al. Sarcopenia and body mass index predict sunitinib-induced early dose-limiting toxicities in renal cancer patients. Br J Cancer. 2013;108:1034–41.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Metter EJ, Talbot LA, Schrager M, Conwit R. Skeletal muscle strength as a predictor of all-cause mortality in healthy men. J Gerontol A Biol Sci Med Sci. 2002;57:B359–65.

    Article  PubMed  Google Scholar 

  21. Tsai S. Importance of lean body mass in the oncologic patient. Nutr Clin Pract. 2012;27:593–8.

    Article  PubMed  Google Scholar 

  22. Peng P, Hyder O, Firoozmand A, Kneuertz P, Schulick RD, Huang D, et al. Impact of sarcopenia on outcomes following resection of pancreatic adenocarcinoma. J Gastrointest Surg. 2012;16:1478–86.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Lieffers JR, Bathe OF, Fassbender K, Winget M, Baracos VE. Sarcopenia is associated with postoperative infection and delayed recovery from colorectal cancer resection surgery. Br J Cancer. 2012;107:931–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Peng PD, van Vledder MG, Tsai S, de Jong MC, Makary M, Ng J, et al. Sarcopenia negatively impacts short-term outcomes in patients undergoing hepatic resection for colorectal liver metastasis. HPB (Oxford). 2011;13:439–46.

    Article  Google Scholar 

  25. Miyamoto Y, Baba Y, Sakamoto Y, Ohuchi M, Tokunaga R, Kurashige J, et al. Sarcopenia is a negative prognostic factor after curative resection of colorectal cancer. Ann Surg Oncol. 2015;22:2663–8.

    Article  PubMed  Google Scholar 

  26. Reisinger KW, van Vugt JL, Tegels JJ, Snijders C, Hulsewe KW, Hoofwijk AG, et al. Functional compromise reflected by sarcopenia, frailty, and nutritional depletion predicts adverse postoperative outcome after colorectal cancer surgery. Ann Surg. 2015;261:345–52.

    Article  PubMed  Google Scholar 

  27. Krell RW, Kaul DR, Martin AR, Englesbe MJ, Sonnenday CJ, Cai S, et al. Association between sarcopenia and the risk of serious infection among adults undergoing liver transplantation. Liver Transpl. 2013;19:1396–402.

    Article  PubMed  Google Scholar 

  28. Onodera T, Goseki N. Kosaki G [Prognostic nutritional index in gastrointestinal surgery of malnourished cancer patients]. Nihon Geka Gakkai Zasshi. 1984;85:1001–5.

    CAS  PubMed  Google Scholar 

  29. Englesbe MJ, Lee JS, He K, Fan L, Schaubel DE, Sheetz KH, et al. Analytic morphomics, core muscle size, and surgical outcomes. Ann Surg. 2012;256:255–61.

    Article  PubMed  Google Scholar 

  30. Mourtzakis M, Prado CM, Lieffers JR, Reiman T, McCargar LJ, Baracos VE. A practical and precise approach to quantification of body composition in cancer patients using computed tomography images acquired during routine care. Appl Physiol Nutr Metab. 2008;33:997–1006.

    Article  PubMed  Google Scholar 

  31. Uchino M, Ikeuchi H, Matsuoka H, Tsuchida T, Tomita N, Takesue Y. Risk factors associated with surgical site infection after ileal pouch-anal anastomosis in ulcerative colitis. Dis Colon Rectum. 2010;53:143–9.

    Article  PubMed  Google Scholar 

  32. Madbouly KM, Senagore AJ, Remzi FH, Delaney CP, Waters J, Fazio VW. Perioperative blood transfusions increase infectious complications after ileoanal pouch procedures (IPAA). Int J Colorectal Dis. 2006;21:807–13.

    Article  PubMed  Google Scholar 

  33. Kiely JM, Fazio VW, Remzi FH, Shen B, Kiran RP. Pelvic sepsis after IPAA adversely affects function of the pouch and quality of life. Dis Colon Rectum. 2012;55:387–92.

    Article  PubMed  Google Scholar 

  34. Ziv Y, Fazio VW, Church JM, Lavery IC, King TM, Ambrosetti P. Stapled ileal pouch anal anastomoses are safer than handsewn anastomoses in patients with ulcerative colitis. Am J Surg. 1996;171:320–3.

    Article  CAS  PubMed  Google Scholar 

  35. Voron T, Tselikas L, Pietrasz D, Pigneur F, Laurent A, Compagnon P, et al. Sarcopenia Impacts on Short- and Long-term Results of Hepatectomy for Hepatocellular Carcinoma. Ann Surg. 2014;261:1173–83.

    Article  Google Scholar 

  36. Hrnciarikova D, Juraskova B, Zadak Z, Hronek M. Present state of evaluating malnutrition in the elderly–analysing indicators. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2006;150:217–21.

    Article  PubMed  Google Scholar 

  37. Reijnierse EM, Trappenburg MC, Leter MJ, Sipila S, Stenroth L, Narici MV, et al. Serum albumin and muscle measures in a cohort of healthy young and old participants. Age (Dordr). 2015;37:88.

    Article  CAS  Google Scholar 

  38. Schaap LA, Pluijm SM, Deeg DJ, Visser M. Inflammatory markers and loss of muscle mass (sarcopenia) and strength. Am J Med. 2006;119(526):e9–17.

    Google Scholar 

  39. Reisinger KW, Derikx JP, van Vugt JL, Von Meyenfeldt MF, Hulsewe KW, Olde Damink SW, et al. Sarcopenia is associated with an increased inflammatory response to surgery in colorectal cancer. Clin Nutr. 2015. doi:10.1016/j.clnu.2015.07.005.

  40. Bastiaanse LP, Hilgenkamp TI, Echteld MA, Evenhuis HM. Prevalence and associated factors of sarcopenia in older adults with intellectual disabilities. Res Dev Disabil. 2012;33:2004–12.

    Article  PubMed  Google Scholar 

  41. Hasselager R, Gogenur I. Core muscle size assessed by perioperative abdominal CT scan is related to mortality, postoperative complications, and hospitalization after major abdominal surgery: a systematic review. Langenbecks Arch Surg. 2014;399:287–95.

    Article  PubMed  Google Scholar 

  42. Prado CM, Birdsell LA, Baracos VE. The emerging role of computerized tomography in assessing cancer cachexia. Curr Opin Support Palliat Care. 2009;3:269–75.

    Article  PubMed  Google Scholar 

  43. Shen W, Punyanitya M, Wang Z, Gallagher D, St-Onge MP, Albu J, et al. Total body skeletal muscle and adipose tissue volumes: estimation from a single abdominal cross-sectional image. J Appl Physiol. 1985;2004(97):2333–8.

    Google Scholar 

  44. Joglekar S, Nau PN, Mezhir JJ. The impact of sarcopenia on survival and complications in surgical oncology: a review of the current literature. J Surg Oncol. 2015;112:503–9.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Reparative Medicine, Department of Gastrointestinal and Pediatric Surgery, Institute of Life Sciences, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan

    Hiroyuki Fujikawa, Toshimitsu Araki, Yoshiki Okita, Satoru Kondo, Mikio Kawamura, Junichiro Hiro, Yuji Toiyama, Minako Kobayashi, Koji Tanaka, Yasuhiro Inoue, Yasuhiko Mohri, Keiichi Uchida & Masato Kusunoki

Authors
  1. Hiroyuki Fujikawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Toshimitsu Araki
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yoshiki Okita
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Satoru Kondo
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Mikio Kawamura
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Junichiro Hiro
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Yuji Toiyama
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Minako Kobayashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Koji Tanaka
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Yasuhiro Inoue
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Yasuhiko Mohri
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Keiichi Uchida
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Masato Kusunoki
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hiroyuki Fujikawa.

Ethics declarations

Conflicts of interest

Hiroyuki Fujikawa, Toshimitsu Araki, Yoshiki Okita, Satoru Kondo, Mikio Kawamura, Junichiro Hiro, Yuji Toiyama, Minako Kobayashi, Koji Tanaka, Yasuhiro Inoue, Yasuhiko Mohri, Keiichi Uchida, and Masato Kusunoki declare that they have no conflicts of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Fujikawa, H., Araki, T., Okita, Y. et al. Impact of sarcopenia on surgical site infection after restorative proctocolectomy for ulcerative colitis. Surg Today 47, 92–98 (2017). https://doi.org/10.1007/s00595-016-1357-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00595-016-1357-x

Keywords

Search

Navigation