Dronkers J.1,2, Winkels R.3,4, van Baar H.3, Veenhof C.5, Kampman E.3
1University of Applied Sciences Utrecht, Utrecht, Netherlands, 2Gelderse Vallei Hospital, Ede, Netherlands, 3Wageningen University & Research, Wageningen, Netherlands, 4Penn State University, Hershey, United States, 5University Medical Center Utrecht, Utrecht, Netherlands
Background: Physical fitness is related to the recovery after major abdominal surgery. Muscle function is an important determinant of physical fitness and can be measured in different ways. Muscle mass (MM) has an important role as protein store of the body which is required to cope with surgical stress and inflammatory processes. Muscle strength (MS) and muscle power (MP) are related with functional mobility. Physical activity (PA) addresses the role of the muscle as secretory organ of myokines with positive health related effects.
Purpose: The purpose of this study is to determine the association of preoperative muscle mass, strength and power with postoperative functional mobility, inhospital and 5-years mortality.
Methods: Prospective cohort study including 208 patients aged over 60 years who had to undergo surgery due to colorectal cancer. Muscle mass (MM) was quantified from diagnostic CT-scans at the level of the third lumbar vertebrae using SliceOmatic software and was normalized for height to obtain the skeletal muscle mass index. Muscle strength (MS) was measured as hand grip strength, muscle power (MP) by chair rise test and physical activity (PA) by a self-reported physical activity questionnaire. All determinants were dichotomized. Postoperative functional mobility was measured as the ability to return to the home environment (discharge destination). The association of muscle functions with discharge destination and inhospital mortality was analyzed with univariate and multiple logistic regression analysis. The association with 5-years mortality is determined by univariate and multiple cox regression analysis.
Results: Inhospital mortality was significantly associated with MM (OR 5.5; CI 1.5-19.6) and MS (OR 4.6; CI 1.2-17.2) and not significantly with MP (OR 1.4; CI 0.4-5.6) and PA (OR 3.1; CI 0.9-10.4). Multiple regression analysis revealed MM (OR 4.1; CI 1.1-15.7) and MS (OR 4.0; CI 1.0 15.2) both as independently related factors. Discharge destination was significantly associated with MS (OR 4.8; CI 1.8-13.3) and not significantly with MM (OR 1.4; CI 0.5-3.7), CRT (OR 2.9; CI 0.9-8.8) and PA(OR 2.1; CI 0.9-5.2). The 5-years mortality is significantly associated with MM (HR 2.0; p 0.01), MS (HR 1.7; 1.1-2.7) and PA (HR 1.9; 1.2-2.9) and not significantly with MP (OR1.1; CI 0.7-1.7). Multiple regression analysis revealed MM (OR 1.7; CI 1.0-2.7)and PA (OR 1.7; CI 1.1-2.7) as independently related factors factors.
Conclusion(s): Muscle function is associated with short term recovery and long term survival time. In accordance with their distinct functions muscle strength is related with postoperative recovery of functional mobility and the ability to do things independently. Muscle mass is related to both short term and long term mortality and physical activity is related to long term survival. As could be expected, the strength of the relationship decreases over time.
Future research should focus on postoperative monitoring the different muscle functions over time to make the relationship more accurate.
Implications: The results of this study addresses the role of the muscle organ in surgical care. The three different functions can be brought into care as risk stratification and as modifiable factors which can be improved during the preoperative period.
Funding acknowledgements: This work was not funded
Topic: Oncology, HIV & palliative care
Ethics approval: This work was by approved by the local Medical Ethics Committee of the Gelderse Vallei Hospital
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