Inflamm Bowel Dis. 2024 Aug 23:izae187. doi: 10.1093/ibd/izae187. Online ahead of print.

Ria Minawala ¹, Michelle Kim ¹, Olivia Delau ², Ghoncheh Ghiasian ², Anna Sophia McKenney ³, Andre Da Luz Moreira ², Joshua Chodosh ⁴, Mara McAdams-DeMarco ⁵, Dorry L Segev ⁵, Samrachana Adhikari ⁶, John Dodson ⁷, Aasma Shaukat ², Bari Dane ⁸, Adam S Faye ²

Author information

¹Department of Medicine, NYU School of Medicine, New York, NY, USA.

²Inflammatory Bowel Disease Center, Division of Gastroenterology, Department of Medicine, NYU School of Medicine, New York, NY, USA.

³Department of Radiology, New York-Presbyterian Weill Cornell Medical College, New York, NY, USA.

⁴Division of Geriatric Medicine and Palliative Care, Department of Medicine, NYU School of Medicine, New York, NY, USA.

⁵Department of Surgery, NYU School of Medicine, New York, NY, USA.

⁶Department of Population Health, NYU School of Medicine, New York, NY, USA.

⁷Division of Cardiology, Department of Medicine, NYU School of Medicine, New York, NY, USA.

⁸Department of Radiology, NYU School of Medicine, New York, NY, USA.

Abstract

Background: Sarcopenia has been associated with adverse postoperative outcomes in older age cohorts, but has not been assessed in older adults with inflammatory bowel disease (IBD). Further, current assessments of sarcopenia among all aged individuals with IBD have used various measures of muscle mass as well as cutoffs to define its presence, leading to heterogeneous findings.

Methods: In this single-institution, multihospital retrospective study, we identified all patients aged 60 years and older with IBD who underwent disease-related intestinal resection between 2012 and 2022. Skeletal Muscle Index (SMI) and Total Psoas Index (TPI) were measured at the superior L3 endplate on preoperative computed tomography scans and compared through receiver operating characteristic curve. We then performed multivariable logistic regression to assess risk factors associated with an adverse 30-day postoperative outcome. Our primary outcome included a 30-day composite of postoperative mortality and complications, including infection, bleeding, cardiac event, cerebrovascular accident, acute kidney injury, venous thromboembolism, reoperation, all-cause rehospitalization, and need for intensive care unit-level care.

Results: A total of 120 individuals were included. Overall, 52% were female, 40% had ulcerative colitis, 60% had Crohn's disease, and median age at time of surgery was 70 years (interquartile range: 65-75). Forty percent of older adults had an adverse 30-day postoperative outcome, including infection (23%), readmission (17%), acute kidney injury (13%), bleeding (13%), intensive care unit admission (10%), cardiac event (8%), venous thromboembolism (7%), reoperation (6%), mortality (5%), and cerebrovascular accident (2%). When evaluating the predictive performance of SMI vs TPI for an adverse 30-day postoperative event, SMI had a significantly higher area under the curve of 0.66 (95% CI, 0.56-0.76) as compared to 0.58 (95% CI, 0.48-0.69) for TPI (P = .02). On multivariable logistic regression, prior IBD-related surgery (adjusted odds ratio [adjOR] 6.46, 95% CI, 1.85-22.51) and preoperative sepsis (adjOR 5.74, 95% CI, 1.36-24.17) significantly increased the odds of adverse postoperative outcomes, whereas increasing SMI was associated with a decreased risk of an adverse postoperative outcome (adjOR 0.88, 95% CI, 0.82-0.94).

Conclusions: Sarcopenia, as measured by SMI, is associated with an increased risk of postoperative complications among older adults with IBD. Measurement of SMI from preoperative imaging can help risk stratify older adults with IBD undergoing intestinal resection.