Effects of sarcopenia on functional improvement over the first year after cardiac surgery: a cohort study

Abstract

Background:

Sarcopenia is linked with poor postoperative outcomes.

Aims:

To evaluate the effects of sarcopenia on first-year functional changes after cardiac surgery.

Methods:

In this prospective cohort study, functional changes (physical activity levels in metabolic equivalent hours/week, 6-minute walking distance in metres, and grip strength in kg) from preoperative baseline to 1, 3, 6 and 12 months postoperatively were compared in adult patients with and without sarcopenia undergoing cardiac surgery at a tertiary medical centre. Presurgical sarcopenia was defined as low muscle mass plus either low strength or poor physical performance (i.e. reduced gait speed). Secondary outcomes (length of hospital stay and 1-year mortality) were compared between sarcopenia and non-sarcopenia groups.

Results:

Sarcopenia presented in 27.7% (n=67) of 242 participants. Participants with sarcopenia were significantly older, predominantly women, and had lower body mass index and higher cardiac surgery risk (measured by the EuroSCORE II) than those without sarcopenia. For both groups, physical activity levels, walking distance and grip strength steadily improved over the year following cardiac surgery. Independent of EuroSCORE II, changes in physical activity levels, walking distance and grip strength did not differ significantly between the sarcopenia and non-sarcopenia groups 1, 3, 6 and 12 months after surgery. Nevertheless, the sarcopenia group had a significantly longer length of hospital stay than the non-sarcopenia group (19.4 vs. 15.3 days; β=2.9, P=0.02) but 1-year mortality (3.4 vs. 3.9% for non-sarcopenia group) was comparable.

Conclusions:

Despite a longer length of hospital stay for the sarcopenia group, sarcopenia was not a restriction for cardiac surgery given their comparable functional improvement and mortality 1 year following surgery.

Keywords

Sarcopenia recovery functional change cardiac surgery length of stay 1-year mortality

Get full access to this article

View all access options for this article.

References

Cruz-Jentoft

Baeyens

Bauer

et al . Sarcopenia: European consensus on definition and diagnosis. Age Ageing 2010; 39: 412–423.

Chen

Liu

Woo

et al . Sarcopenia in Asia: consensus report of the Asian working group for sarcopenia. J Am Med Dir Assoc 2014; 15: 95–101.

Tanimoto

Watanabe

Sun

et al . Association between muscle mass and disability in performing instrumental activities of daily living (IADL) in community-dwelling elderly in Japan. Arch Gerontol Geriatr 2012; 54: e230–e233.

Ikeno

Koide

Abe

et al . Impact of sarcopenia on the outcomes of elective total arch replacement in the elderly. Eur J Cardio-Thoracic Surg 2017; 51: 1135–1141.

vanVenrooij

LMW

deVos

Zijlstra

et al . The impact of low preoperative fat-free body mass on infections and length of stay after cardiac surgery: a prospective cohort study. J Thorac Cardiovasc Surg 2011; 142: 1263–1269.

Weig

Milger

Langhans

et al . Core muscle size predicts postoperative outcome in lung transplant candidates. Ann Thorac Surg 2016; 101: 1318–1325.

Nishida

Kato

Kudo

et al . Preoperative sarcopenia strongly influences the risk of postoperative pancreatic fistula formation after pancreaticoduodenectomy. J Gastrointest Surg 2016; 20: 1586–1594.

Lieffers

Bathe

Fassbender

et al . Sarcopenia is associated with postoperative infection and delayed recovery from colorectal cancer resection surgery. Br J Cancer 2012; 107: 931–936.

Englesbe

Patel

et al . Sarcopenia and mortality after liver transplantation. J Am Coll Surg 2010; 211: 271–278.

10.

Sündermann

Dademasch

Praetorius

et al . Comprehensive assessment of frailty for elderly high-risk patients undergoing cardiac surgery. Eur J Cardio-Thoracic Surg 2011; 39: 33–37.

11.

Sepehri

Beggs

Hassan

et al . The impact of frailty on outcomes after cardiac surgery: a systematic review. J Thorac Cardiovasc Sur 2014; 148: 3110–3117.

12.

Cederholm

Overlaps between frailty and sarcopenia definitions. In: Fielding

Sieber

Vellas

(eds) Frailty: Pathophysiology, Phenotype and Patient Care. Basel: Karger, 2015, pp. 65–70.

13.

Nashef

SAM

Roques

Sharples

et al . Euroscore II. Eur J Cardio-Thoracic Surg 2012; 41: 734–745.

14.

Verovská

Lacnák

Haluzíková

et al . Comparison of various methods of body fat analysis in overweight and obese women. Vnitr Lek 2009; 55: 455–461.

15.

Lauretani

Russo

CRSB

Bartali

et al . Age-associated changes in skeletal muscles and their effect on mobility: an operational diagnosis of sarcopenia. J Appl Physiol 2003; 95: 1851–1860.

16.

The IPAQ group. Guidelines for data processing and analysis of the International Physical Activity Questionnaire (IPAQ) – short and long forms. https://sites.google.com/site/theipaq/ (2016, accessed 21 July 2018).

17.

Faggiano

D’Aloia

Gualeni

et al . The 6 minute walking test in chronic heart failure: indications, interpretation and limitations from a review of the literature. Eur J Heart Fail 2004; 6: 687–691.

18.

Bhatti

Grayson

Grotte

et al . The logistic EuroSCORE in cardiac surgery: how well does it predict operative risk? Heart 2006; 92: 1817–1820.

19.

Harrison

Hayes

Newman

Level of physical activity and characteristics associated with change following breast cancer diagnosis and treatment. Psycho-Oncology 2009; 18: 387–394.

20.

Alexander

Anstrom

Muhlbaier

et al . Outcomes of cardiac surgery in patients age ⩾80 years: results from the National Cardiovascular Network. J Am Coll Cardiol 2000; 35: 731–738.

21.

Lee

Buth

Martin

et al . Frail patients are at increased risk for mortality and prolonged institutional care after cardiac surgery. Circulation 2010; 121: 973–978.

22.

Schoenenberger

Stortecky

Neumann

et al . Predictors of functional decline in elderly patients undergoing transcatheter aortic valve implantation (TAVI). Eur Heart J 2013; 34: 684–692.

23.

Stortecky

Schoenenberger

Moser

et al . Evaluation of multidimensional geriatric assessment as a predictor of mortality and cardiovascular events after transcatheter aortic valve implantation. JACC: Cardiovas Interventions 2012; 5: 489–496.

24.

Fried

Tangen

Walston

et al . Frailty in older adults: evidence for a phenotype. J Gerontology Ser A: Biol Sci Med Sci 2001; 56: M146–M157.

25.

Enright

PL.

The six-minute walk test. Respir Care 2003; 48: 783–785.

26.

Dillon

Sheffield-Moore

Paddon-Jones

et al . Amino acid supplementation increases lean body mass, basal muscle protein synthesis, and insulin-like growth factor-I expression in older women. J Clin Endocrinol Metab 2009; 94: 1630–1637.

27.

Kim

Suzuki

Saito

et al . Effects of exercise and amino acid supplementation on body composition and physical function in community-dwelling elderly Japanese sarcopenic women: a randomized controlled trial. J Am Geriatr Soc 2012; 60: 16–23.

28.

Colella

TJF

Gravely

Marzolini

et al . Sex bias in referral of women to outpatient cardiac rehabilitation? A meta-analysis. Eur J Prev Cardiol 2015; 22: 423–441.

29.

Giallauria

Vigorito

Tramarin

et al . Cardiac rehabilitation in very old patients: data from the Italian Survey on Cardiac Rehabilitation – 2008 (ISYDE-2008) – official report of the Italian Association for Cardiovascular Prevention, Rehabilitation, and Epidemiology. J Gerontol Ser A: Biomed Sci Med Sci 2010; 65: 1353–1361.

30.

Lin

Hsiung

et al . Epidemiology of sarcopenia among community-dwelling older adults in Taiwan: a pooled analysis for a broader adoption of sarcopenia assessments. Geriatrics Gerontology Int 2014; 14: 52–60.

31.

Mok

Allende

Leipsic

et al . Prognostic value of fat mass and skeletal muscle mass determined by computed tomography in patients who underwent transcatheter aortic valve implantation. Am J Cardiol 2016; 117: 828–833.

32.

vanVenrooij

Verberne

deVos

et al . Preoperative and postoperative agreement in fat free mass (FFM) between bioelectrical impedance spectroscopy (BIS) and dual-energy X-ray absorptiometry (DXA) in patients undergoing cardiac surgery. Clin Nutr 2010; 29: 789–794.