Morphometric and Functional Markers as Determinants of Perioperative Risk Öffentlichkeit

Mbanya, Armand (Summer 2020)

Permanent URL: https://etd.library.emory.edu/concern/etds/v692t7355?locale=de
Published

Abstract

Background: The U.S. population is getting older and in need of more high risk surgical procedures. Perioperative risk assessment is a growing field in response to this need and

perioperative outcomes such as hospital length of stay are used to evaluate the quality of service in hospitals. Functional and morphometric markers of fitness such as hand grip strength and psoas area are strong predictors of perioperative adverse events. This study assesses the relationship between markers of fitness and perioperative outcomes.

Method: We recruited a cohort of 198 patients scheduled for surgery and measured elements of their physical fitness including hand grip strength, hip strength, and psoas area during their presurgical visit. They were followed up to 30 days after surgery. We then performed analyses to evaluate the relationship between different markers of fitness and the postoperative outcomes we observed.

Results: Our population’s median age was 60 [51-70], 59.1% were male and 85% classified ASA III. Women in the study had lower lean mass and higher body fat percentages. Men had higher measures for strength markers across the board. Low lean mass and BMI were associated with worse ASA scores. OE ratio was higher in females. Total lean mass (r=0.45), skeletal muscle mass (r= 0.47) and trunk lean mass (0.55) had moderate positive correlations to psoas muscle area while grip strength had a weak correlation (r=0.25) to psoas muscle area, all controlling for age and sex.

Conclusion: Improving hand grip strength, psoas strength and body composition before surgery may help reduce perioperative risk. Functional and morphometric markers of fitness are feasible in clinical setting and should be routinely used in pre-surgical workflow.

Table of Contents

CHAPTER 1: INTRODUCTION .................................................................................................................................. 1

Specific Aim ...............................................................................................................................................................3

Research Hypothesis..................................................................................................................................................3

CHAPTER 2: LITERATURE REVIEW........................................................................................................................... 4

SURGERY OVERVIEW .................................................................................................................................................4

Perioperative Risk Assessment .............................................................................................................................5

PHYSICAL FITNESS......................................................................................................................................................9

Cardio-Respiratory Fitness....................................................................................................................................9

Muscular Strength ..............................................................................................................................................11

Lower Limb Strength...........................................................................................................................................14

Body Composition...............................................................................................................................................16

MORPHOMETRIC MARKERS FROM PREOPERATIVE IMAGING................................................................................21

Trunk muscle size and density ............................................................................................................................21

Adiposity distribution..........................................................................................................................................22

CHAPTER 3: METHODS......................................................................................................................................... 23

Study Design............................................................................................................................................................23

Inclusion and Exclusion Criteria:..............................................................................................................................23

Data Collection:.......................................................................................................................................................23

Data Analysis...........................................................................................................................................................27

CHAPTER 4: RESULTS ........................................................................................................................................... 28

Table 2: Demographics of study participants..........................................................................................................28

Table 3: Functional, Morphometric Markers, and Outcomes categorized by Gender.............................................30

Table 4: Functional, Morphometric Markers, and Outcomes categorized by Age Groups......................................31

Table 5: Functional, Morphometric Markers, and Outcomes categorized by ASA Classification............................32

Figure 2: Partial Correlations between Functional & Morphometrics Markers. .....................................................33

CHAPTER 5: DISCUSSION...................................................................................................................................... 34

CONCLUSION ....................................................................................................................................................... 38

BIBLIOGRAPHY..................................................................................................................................................... 39

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