Sarcopenia Is an Independent Predictor for Mortality and Morbidity in Coronary Bypass Surgery

Objectives: The study aimed to investigate the potential role of preoperative measurement of thoracic muscle density as a marker for sarcopenia and frailty in patients undergoing coronary bypass surgery.

Methods: Preoperative CT-derived measurements of cross-sectional area and muscle density (Hounsfield units) of 480 consecutive patients undergoing coronary bypass surgery between January 2017 and December 2019 were retrospectively analyzed.

Axial reconstructions were used to measure pectoral, intercostal, interspinal, latissimus dorsi, and serratus muscles at the level of the 4th thoracic vertebra and the erector spinae at the level of the 12th vertebra.

The lower quartile of muscle density measurements was defined as sarcopenia. Sarcopenic versus nonsarcopenic patients were compared regarding 30-day mortality and perioperative morbidity.

Result: Sarcopenic patients had a significant higher 30-day mortality (4.2% vs. 1.1%, p < 0.05), more major neurologic events (23.5 vs. 8,6%, p < 0.01), higher rates of reintubation (8.4 vs. 1.9%, p < 0.01), acute kidney injury requiring hemodialysis (4.2 vs. 0.6%, p < 0.01), wound infection (8.4 vs. 1.9%, p < 0.01), and postoperative atrial fibrillation (37 vs. 18.3%, p < 0.01). Sarcopenic patients were older (71.5 vs. 67.6 years, p < 0.01), but there were no differences regarding preoperative comorbidities (diabetes, chronic obstructive lung disease, hyperlipidemia, peripheral, and cerebral vascular disease), preoperative medication, mean EuroSCORE II, and operative characteristics (aortic cross–clamp time, perfusion time, and graft choice).

Conclusion: In our series, preoperative low thoracic muscle density was associated with an increase in perioperative mortality and morbidity in patients undergoing coronary bypass surgery. Measurement of thoracic muscle density represents an easy and useful parameter in preoperative risk assessment.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
19 February 2021