Prevalence of sarcopenia in patients with surgical obstructive jaundice and its impact on clinical outcomes.

Background: Sarcopenia is a clinical syndrome presented with progressive and generalized skeletal muscle loss and function dysfunction. Usually, it is considered an age-related process influenced by genetic, lifestyle factors, and diseases. Obstructive jaundice is one of the most common pathophysiological changes in patients needing hepatobiliary or pancreatic operations that can adversely affect the tissue and organ function throughout the human body. However, the effects of obstructive jaundice on the occurrence of sarcopenia remain unclear.

Aim: To investigate the incidence of sarcopenia in patients with surgical obstructive jaundice and the association of sarcopenia with postoperative outcome.

Methods: This cross-sectional study was conducted from December 2019 to January 2024. Data retrieved included patient demographics, disease entities, sarcopenia-related parameters (including grip strength, 6-m walking time, and limb skeletal muscle mass index), postoperative complications, and length of hospital stay. Sarcopenia was confirmed using Asian Working Group standards. Logistic regression was used to analyze the relationship between total bilirubin level and sarcopenia. The factors influencing sarcopenia in patients with surgical obstructive jaundice and association of sarcopenia with postoperative complications were also investigated.

Results: Overall, 1708 patients met the inclusion criteria, with a mean age of 60.09 ± 13.52 years (sex: 52.28% male). There were 383 patients (22.42%) with obstructive jaundice and 1325 (77.58%) without jaundice. Sarcopenia, low walking speed, low grip strength, and low limb skeletal muscle index were more prevalent in patients with obstructive jaundice than nonobstructive jaundice. The odds ratio (OR) for sarcopenia in patients with obstructive jaundice was 1.689 [95% confidence interval (CI): 1.295-2.203, P < 0.001], indicating that jaundice is a significant risk factor for sarcopenia. The occurrence of sarcopenia was higher in patients with severe obstructive jaundice than mild obstructive jaundice (39.3% vs 22.8%, P < 0.05). Obstructive jaundice was positively correlated with reduced walking speed (OR = 1.627, 95%CI: 1.185-2.234, P = 0.003) and decreased grip strength (OR = 1.669, 95%CI: 1.212-2.300, P = 0.002). Age (OR = 1.077, 95%CI: 1.040-1.114, P < 0.001) and body mass index (OR = 0.703, 95%CI: 0.630-0.784, P < 0.001) were independent risk factors of sarcopenia in patients with obstructive jaundice. Patients with obstructive jaundice and sarcopenia had a higher rate of postoperative complications (46.3% vs 33.1%, P = 0.032), longer postoperative hospital stays (11.33 ± 6.75 days vs 9.19 ± 7.32 days, P = 0.016), and longer total hospital stays (17.10 ± 7.69 days vs 15.98 ± 8.55 days, P = 0.032) than those without sarcopenia.

Conclusion: Sarcopenia is more prevalent in patients with obstructive jaundice and is positively correlated with the degree of jaundice. Sarcopenia prolongs hospital stays and is associate with postoperative complications.