Synergistic effect of sarcopenia and ASA status in predicting mortality after emergency laparotomy: a systematic review and meta-analysis with meta-regression.

IF 2.4 3区医学 Q2 SURGERY

Updates in Surgery Pub Date : 2025-01-16 DOI:10.1007/s13304-025-02105-4

Ahmad Al-Sarireh, Hashim Al-Sarireh, Olivia Ambler, Shahin Hajibandeh, Shahab Hajibandeh

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Abstract

The aim of this study was to investigate the relationship between sarcopenia and American Society of Anesthesiologists (ASA) status in predicting post-operative mortality after emergency laparotomy. A PRISMA-compliant systematic review and meta-analysis (using random effects modelling) was performed searching for studies reporting 30-day mortality risk in patients with sarcopenia undergoing emergency laparotomy. The ASA status of sarcopenic and non-sarcopenic patients was determined, and the effect of difference in ASA status on 30-day mortality in sarcopenic and non-sarcopenic patients was determined via a meta-regression model. The risk of bias and certainty was assessed using the QUIPS tool and the GRADE system, respectively. Seven studies comprising 2663 patients were included. Thirty-day mortality risk was 22.9% (95% CI 11.6-40.0%) in sarcopenic patients and 6.2% (95% CI 2.9-13.0%) in non-sarcopenic patients; the risk was significantly higher in sarcopenic patients (OR: 4.452, p = 0.016). In sarcopenic patients, ASA status IV-V increased the risk of mortality (Coefficient: 0.07612, p < 0.0001), while ASA status I-II (Coefficient: - 0.09039, p < 0.0001) or ASA status III (Coefficient: 0.01300, p = 0.344) did not. In non-sarcopenic patients, ASA status III (Coefficient: 0.06830, p < 0.0001) and ASA status IV-V (Coefficient: 0.17809, p < 0.0001) increased the risk of mortality, while ASA status I-II (Coefficient: - 0.05841, p < 0.0001) did not. The GRADE certainty was moderate. Sarcopenia and ASA status are two independent predictors of mortality after emergency laparotomy with no significant collinearity. Sarcopenia and ASA status synergistically increase the risk of mortality after emergency laparotomy. ASA status IV and ASA status III are critical thresholds for increased risk of mortality in sarcopenic and non-sarcopenic patients, respectively.

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骨骼肌减少症和ASA状态在预测急诊剖腹手术后死亡率中的协同作用：一项系统综述和meta回归分析。

本研究的目的是探讨肌肉减少症与美国麻醉医师协会（ASA）在预测急诊剖腹手术后死亡率方面的关系。一项符合prisma标准的系统评价和荟萃分析（使用随机效应模型）进行了搜索报告紧急剖腹手术的肌肉减少症患者30天死亡率风险的研究。测定肌少症和非肌少症患者的ASA状态，并通过meta回归模型确定ASA状态差异对肌少症和非肌少症患者30天死亡率的影响。偏倚风险和确定性分别使用QUIPS工具和GRADE系统进行评估。纳入了包括2663例患者的7项研究。肌肉减少症患者的30天死亡风险为22.9% (95% CI 11.6-40.0%)，非肌肉减少症患者的30天死亡风险为6.2% (95% CI 2.9-13.0%)；肌肉减少症患者的风险明显更高（OR: 4.452, p = 0.016）。在肌肉减少症患者中，ASA状态IV-V增加死亡风险(系数：0.07612,p

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来源期刊

Updates in Surgery Medicine-Surgery

CiteScore

4.50

自引率

7.70%

发文量

208

期刊介绍： Updates in Surgery (UPIS) has been founded in 2010 as the official journal of the Italian Society of Surgery. It’s an international, English-language, peer-reviewed journal dedicated to the surgical sciences. Its main goal is to offer a valuable update on the most recent developments of those surgical techniques that are rapidly evolving, forcing the community of surgeons to a rigorous debate and a continuous refinement of standards of care. In this respect position papers on the mostly debated surgical approaches and accreditation criteria have been published and are welcome for the future. Beside its focus on general surgery, the journal draws particular attention to cutting edge topics and emerging surgical fields that are publishing in monothematic issues guest edited by well-known experts. Updates in Surgery has been considering various types of papers: editorials, comprehensive reviews, original studies and technical notes related to specific surgical procedures and techniques on liver, colorectal, gastric, pancreatic, robotic and bariatric surgery.