Sarcopenia is associated with postoperative infection and delayed recovery from colorectal cancer resection surgery

BACKGROUND: Skeletal muscle depletion (sarcopenia) predicts morbidity and mortality in the elderly and cancer patients. METHODS: We tested whether sarcopenia predicts primary colorectal cancer resection outcomes in stage II-IV patients (n = 234). Sarcopenia was assessed using preoperative computed tomography images. Administrative hospitalisation data encompassing the index surgical admission, direct transfers for inpatient rehabilitation care and hospital re-admissions within 30 days was searched for International Classification of Disease (ICD)-10 codes for postoperative infections and inpatient rehabilitation care and used to calculate length of stay (LOS). RESULTS: Overall, 38.9% were sarcopenic; 16.7% had an infection and 9.0% had inpatient rehabilitation care. Length of stay was longer for sarcopenic patients overall (15.9 +/- 14.2 days vs 12.3 +/- 9.8 days, P = 0.038) and especially in those >= 65 years (20.2 +/- 16.9 days vs 13.1 +/- 8.3 days, P = 0.008). Infection risk was greater for sarcopenic patients overall (23.7% vs 12.5%; P = 0.025), and especially those >= 65 years (29.6% vs 8.8%, P = 0.005). Most (90%) inpatient rehabilitation care was in patients >= 65 years. Inpatient rehabilitation was more common in sarcopenic patients overall (14.3% vs 5.6%; P = 0.024) and those >= 65 years (24.1% vs 10.7%, P = 0.06). In a multivariate model in patients >= 65 years, sarcopenia was an independent predictor of both infection (odds ratio (OR) 4.6, (95% confidence interval (CI) 1.5, 13.9) P < 0.01) and rehabilitation care (OR 3.1 (95% CI 1.04, 9.4) P < 0.04). CONCLUSION: Sarcopenia predicts postoperative infections, inpatient rehabilitation care and consequently a longer LOS. British Journal of Cancer (2012) 107, 931-936. doi:10.1038/bjc.2012.350 www.bjcancer.com Published online 7 August 2012 (C) 2012 Cancer Research UK