Psoas Major Muscle Area As Preoperative Frailty Assessment In Emergency Operation For Acute Aortic Type A Dissection
Shuhei Miura, Sr..
Teine Keijinkai Hospital, Sapporo, Japan.
Objective: It is difficult to assess clinical frailty in the case of acute aortic type A dissection (AAAD) based on emergency operation. The objective is to evaluate the association between psoas major muscle area (PMMA) and early and late outcomes after emergency operation for AAAD. Methods: Between April 2013 and June 2017, 55 patients (67.3±13.3 years old, 28 female) who underwent emergency operation for AAAD were reviewed. PMMA/BSA Index (PABI) was calculated as PMMA between L4 and L5 level on preoperative CT (cm2)/Body Surface Area (m2). The mean PABI (9.8±2.3cm2/m2) obtained from 43 frail patients who underwent TAVI was defined as the cut-off value. The enrolled patients were divided into Group A with PABI<10 (n=26, 7.8±1.5cm2/m2) and Group B with PABI>10 (n=29, 13.2±2.0cm2/m2). Results: The following factors had significant differences between Group A and Group B: age (75.3±8.4 vs 60.1±12.8 years: p<0.001), female gender (84.1% vs 17.2%: p<0.001), total arch replacement (34.6% vs 68.9%: p=0.011), smoking history (38.5% vs 68.8%: p=0.005). Postoperative standing load test (5.5± 4.7 vs 3.1±1.9 days: p=0.027) and 50-m walking test (14.1±11.7 vs 6.4±3.8 days: p=0.045) were required more longer in Group A compared with Group B. There was no significant difference in hospital mortality (10.0% vs 6.9%: p=0.619), however, over 30 days long-hospital stay rate (50.0% vs 24.1%: p=0.047) and the transfer rate (50.7% vs 17.2%: p=0.009) was significantly higher in Group A. In multivariate analysis, the elderly over the age of 80 years (OR=7.43, p=0.003) and low PMMA (OR=3.14, p=0.026) are significantly associated with long-hospital stay. Median follow-up length was 14 months [1-51], 3-5 years cumulative overall survival rate was not significant different between two groups (79% vs 89%, p=0.496). Conclusions: PMMA could be a predictive marker of clinical frailty associated with long-hospital stay after emergency operation for AAAD.
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