The influence of sarcopenia on lower limb bypass and major lower limb amputation outcomes

ABSTRACT NUMBER: NESS PRIZE FOR JUNIOR TRAINEES (BELOW ST3)_4

 

AUTHOR
Ashwin Sivaharan

MAIN ABSTRACT TEXT

Background
This study examined the impact of sarcopenia on clinical outcome in patients who underwent infrainguinal bypass surgery or major lower limb amputation (MLLA).

Methods
Patients undergoing infra-inguinal bypass and MLLA in 2016-2018 were included in this retrospective analysis. Sarcopenia was identified by CT of muscle area at L3 vertebral.
Primary outcome was overall survival, analysed using Cox regression. Secondary outcomes for bypass included ipsilateral MLLA, length of hospital stay, myocardial infarction and surgical-site infection. For the MLLA cohort we included stump infection and breakdown. These were analysed using Fisher’s test (categorical), Mann-Whitney U test (non-parametric) and t-test (parametric).

Results
216 patients (116 bypass, 100 MLLA) were included. 14/116 (12%) of bypass patients and 13/100 (13%) of MLLA patients were sarcopenic. Age, other co-morbidities, and laboratory tests were similar in those with and without sarcopenia. Overall survival was worse for sarcopenic patients (HR for death 5.8; 95%CI 1.8-19.1; p=0.001) in the bypass cohort, however, this was not observed in the MLLA cohort (HR 1.29; 95%CI 0.23-2.62; p=0.7). MLLA occurred more frequently in patients with sarcopenia (7/14 [50%] vs 23/102 [23%]; p=0.046). There was no difference in other secondary outcomes in either cohort.

Conclusion
In the cohort of patients undergoing infrainguinal lower limb bypass, sarcopenia defined using L3 muscle area was significantly associated with overall mortality and MLLA, however sarcopenia was not associated with worse survival in the MLLA group.
Sarcopenia and frailty may be a key factor in stratifying those who should undergo an amputation-first approach to CLTI.