Anesth Pain Med.  2024 Apr;19(2):161-168. 10.17085/apm.23142.

Association between preoperative lumbar skeletal muscle index and postoperative nausea and vomiting in patients undergoing pylorus-preserving pancreatoduodenectomy: a retrospective study

• Kim HI
• Kim KJ
• Kim S
• Kim HD
• Kim SH

• KMID: 2555254
• DOI: http://doi.org/10.17085/apm.23142

Abstract

Background
Sarcopenia is associated with postoperative complications; however, its impact on the quality of postoperative recovery, such as postoperative nausea and vomiting (PONV) and pain, remains unclear. We investigated the association of preoperative lumbar skeletal muscle mass index (LSMI) with PONV, postoperative pain, and complications.
Methods
Medical records of 756 patients who underwent pylorus-preserving pancreatoduodenectomy (PPPD) were retrospectively reviewed. The skeletal muscle areas were measured on abdominal computed tomography (CT) images. LSMI was calculated by dividing the skeletal muscle area by the square of the patient’s height. We analyzed the correlations between preoperative LSMI calibrated with confounding variables and PONV scores, PONV occurrence, pain scores, rescue analgesic administration, postoperative complications, and length of hospital stay.
Results
The median (1Q, 3Q) LSMI was 47.72 (40.74, 53.41) cm2/m2. The incidence rates of PONV according to time period were as follows: post-anesthesia care unit, 42/756 (5.6%); 0–6 h, 54/756 (7.1%); 6–24 h, 120/756 (15.9%); 24–48 h, 46/756 (6.1%); and overall, 234/756 (31.0%). The incidence of PONV was inversely correlated with LSMI 24–48 h post-surgery and overall. LSMI and PONV scores were negatively associated 6–24 h and 24–48 h post-surgery. There was no association between LSMI and postoperative pain scores, rescue analgesic administration, complications, or length of hospital stay.
Conclusions
Preoperative LSMI was associated with PONV in patients undergoing PPPD. Therefore, LSMI measured on preoperative abdominal CT can be a predictive indicator of PONV. Appropriate PONV prophylaxis is necessary in patients with low LSMI before PPPD.

Keyword

Anesthesia recovery period; General anesthesia; Lumbar skeletal muscle index; Postoperative complications; Postoperative nausea and vomiting; Retrospective study; Sarcopenia; X-Ray computed tomography

Reference

1. Baek JY, Jung HW, Kim KM, Kim M, Park CY, Lee KP, et al. Korean Working Group on Sarcopenia guideline: expert consensus on sarcopenia screening and diagnosis by the Korean Society of Sarcopenia, the Korean Society for Bone and Mineral Research, and the Korean Geriatrics Society. Ann Geriatr Med Res. 2023; 27:9–21.

2. 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.

3. Beaudart C, Zaaria M, Pasleau F, Reginster JY, Bruyère O. Health outcomes of sarcopenia: a systematic review and meta-analysis. PLoS One. 2017; 12:e0169548.

4. Wannamethee SG, Atkins JL. Muscle loss and obesity: the health implications of sarcopenia and sarcopenic obesity. Proc Nutr Soc. 2015; 74:405–12.

5. Zhang H, Lin S, Gao T, Zhong F, Cai J, Sun Y, et al. Association between sarcopenia and metabolic syndrome in middle-aged and older non-obese adults: a systematic review and meta-analysis. Nutrients. 2018; 10:364.

6. Itoh S, Shirabe K, Yoshizumi T, Takeishi K, Harimoto N, Ikegami T, et al. Skeletal muscle mass assessed by computed tomography correlates to muscle strength and physical performance at a liver‐related hospital experience. Hepatol Res. 2016; 46:292–7.

7. Gong G, Wan W, Zhang X, Liu Y, Liu X, Yin J. Correlation between the Charlson comorbidity index and skeletal muscle mass/physical performance in hospitalized older people potentially suffering from sarcopenia. BMC Geriatr. 2019; 19:367.

8. Xiao J, Caan BJ, Feliciano EMC, Meyerhardt JA, Peng PD, Baracos VE, et al. Association of low muscle mass and low muscle radiodensity with morbidity and mortality for colon cancer surgery. JAMA Surg. 2020; 155:942–9.

9. Oh J, Shin WJ, Jeong D, Yun TJ, Park CS, Choi ES, et al. Low muscle mass as a prognostic factor for early postoperative outcomes in pediatric patients undergoing the Fontan operation: a retrospective cohort study. J Clin Med. 2019; 8:1257.

10. Kiriya Y, Toshiaki N, Shibasaki I, Ogata K, Ogawa H, Takei Y, et al. Sarcopenia assessed by the quantity and quality of skeletal muscle is a prognostic factor for patients undergoing cardiac surgery. Surg Today. 2020; 50:895–904.

11. Chae MS, Kim JW, Jung JY, Choi HJ, Chung HS, Park CS, et al. Analysis of pre-and intraoperative clinical factors for successful operating room extubation after living donor liver transplantation: a retrospective observational cohort study. BMC Anesthesiol. 2019; 19:112.

12. Chae MS, Moon KU, Jung JY, Choi HJ, Chung HS, Park CS, et al. Perioperative loss of psoas muscle is associated with patient survival in living donor liver transplantation. Liver Transpl. 2018; 24:623–33.

13. Melloul E, Lassen K, Roulin D, Grass F, Perinel J, Adham M, et al. Guidelines for perioperative care for pancreatoduodenectomy: enhanced recovery after surgery (ERAS) recommendations 2019. World J Surg. 2020; 44:2056–84.

14. Bozzetti F. Forcing the vicious circle: sarcopenia increases toxicity, decreases response to chemotherapy and worsens with chemotherapy. Ann Oncol. 2017; 28:2107–18.

15. Da Rocha IMG, Marcadenti A, De Medeiros GOC, Bezerra RA, Rego JFdM, Gonzalez MC, et al. Is cachexia associated with chemotherapy toxicities in gastrointestinal cancer patients? A prospective study. J Cachexia Sarcopenia Muscle. 2019; 10:445–54.

16. Jin WH, Mellon EA, Frakes JM, Murimwa GZ, Hodul PJ, Pimiento JM, et al. Impact of sarcopenia in borderline resectable and locally advanced pancreatic cancer patients receiving stereotactic body radiation therapy. J Gastrointest Oncol. 2018; 9:24–34.

17. Apfel CC, Läärä E, Koivuranta M, Greim CA, Roewer N. A simplified risk score for predicting postoperative nausea and vomiting: conclusions from cross-validations between two centers. Anesthesiology. 1999; 91:693–700.

18. Gan TJ, Belani KG, Bergese S, Chung F, Diemunsch P, Habib AS, et al. Fourth consensus guidelines for the management of postoperative nausea and vomiting. Anesth Analg. 2019; 131:411–48.

19. Weibel S, Rücker G, Eberhart LH, Pace NL, Hartl HM, Jordan OL, et al. Drugs for preventing postoperative nausea and vomiting in adults after general anaesthesia: a network meta‐analysis. Cochrane Database Syst Rev. 2020; 10:CD012859.

20. Kapur PA. The big “little problem”. Anesth Analg. 1991; 73:243–5.

21. Apfel C, Heidrich F, Jukar-Rao S, Jalota L, Hornuss C, Whelan RP, et al. Evidence-based analysis of risk factors for postoperative nausea and vomiting. Br J Anaesth. 2012; 109:742–53.

22. Apfel CC, Philip BK, Cakmakkaya OS, Shilling A, Shi YY, Leslie JB, et al. Who is at risk for postdischarge nausea and vomiting after ambulatory surgery? Anesthesiology. 2012; 117:475–86.

23. Horn CC, Wallisch WJ, Homanics GE, Williams JP. Pathophysiological and neurochemical mechanisms of postoperative nausea and vomiting. Eur J Pharmacol. 2014; 722:55–66.

24. Zhong W, Shahbaz O, Teskey G, Beever A, Kachour N, Venketaraman V, et al. Mechanisms of nausea and vomiting: current knowledge and recent advances in intracellular emetic signaling systems. Int J Mol Sci. 2021; 22:5797.

25. De Winter BY, Van den Wijngaard RM, De Jonge WJ. Intestinal mast cells in gut inflammation and motility disturbances. Biochim Biophys Acta. 2012; 1822:66–73.

26. Spiller R. Serotonin and GI clinical disorders. Neuropharmacology. 2008; 55:1072–80.

27. Mutoh T, Tsubone H, Nishimura R, Sasaki N. Effects of volatile anesthetics on vagal C-fiber activities and their reflexes in anesthetized dogs. Respir Physiol. 1998; 112:253–64.

28. Kurz A, Sessler DI. Opioid-induced bowel dysfunction: pathophysiology and potential new therapies. Drugs. 2003; 63:649–71.

29. Tankel J, Dagan A, Vainberg E, Boaz E, Mogilevsky L, Hadas I, et al. Sarcopenia is associated with a greater incidence of delayed gastric emptying following pancreaticoduodenectomy. Clin Nutr ESPEN. 2018; 27:105–9.

30. Shintakuya R, Sasaki M, Nakamitsu A, Kohyama M, Tazaki T, Sugiyama Y, et al. Sarcopenia is an independent predictor of delayed gastric emptying following pancreaticoduodenectomy: a retrospective study. ANZ J Surg. 2019; 89:E433–7.

31. Simonsen C, De Heer P, Bjerre ED, Suetta C, Hojman P, Pedersen BK, et al. Sarcopenia and postoperative complication risk in gastrointestinal surgical oncology: a meta-analysis. Ann Surg. 2018; 268:58–69.

32. Guo Z, Gu C, Gan S, Li Y, Xiang S, Gong L, et al. Sarcopenia as a predictor of postoperative outcomes after urologic oncology surgery: A systematic review and meta-analysis. Urol Oncol. 2020; 38:560–73.

33. Jung HE, Han DH, Koo BN, Kim J. Effect of sarcopenia on postoperative ICU admission and length of stay after hepatic resection for Klatskin tumor. Front Oncol. 2023; 13:1136376.

34. Sakai Y, Matsui H, Ito S, Hida T, Ito K, Koshimizu H, et al. Sarcopenia in elderly patients with chronic low back pain. Osteoporos Sarcopenia. 2017; 3:195–200.

35. Choi S, Nah S, Jang H, Moon J, Han S. Association between relative handgrip strength and chronic lower back pain: a nationwide cross-sectional analysis of the Korea National Health and nutrition examination survey. Int J Environ Res Public Health. 2021; 18:10770.

36. Tsuji H, Tetsunaga T, Tetsunaga T, Misawa H, Oda Y, Takao S, et al. Evaluation of SARC-F and SARC-CalF for sarcopenia screening in patients with chronic musculoskeletal pain: A prospective cross-sectional study. Medicine (Baltimore). 2022; 101:e29568.

37. Boutin RD, Yao L, Canter RJ, Lenchik L. Sarcopenia: current concepts and imaging implications. AJR Am J Roentgenol. 2015; 205:W255–66.

38. Guerri S, Mercatelli D, Gómez MPA, Napoli A, Battista G, Guglielmi G, et al. Quantitative imaging techniques for the assessment of osteoporosis and sarcopenia. Quant Imaging Med Surg. 2018; 8:60–85.

39. Rossi F, Valdora F, Bignotti B, Torri L, Succio G, Tagliafico AS. Evaluation of body computed tomography-determined sarcopenia in breast cancer patients and clinical outcomes: a systematic review. Cancer Treat Res Commun. 2019; 21:100154.

40. Albano D, Messina C, Vitale J, Sconfienza LM. Imaging of sarcopenia: old evidence and new insights. Eur Radiol. 2020; 30:2199–208.