The effect of sarcopenia on outcomes following orthopedic surgery: a systematic review

Filip Brzeszczyński, Joanna Brzeszczyńska, Andrew Duckworth, Iain Murray, A Hamish R W Simpson, David Hamilton

Research output: Contribution to journalArticlepeer-review

Abstract / Description of output

Background
Sarcopenia is characterised by a generalised progressive loss of skeletal muscle mass, strength, and physical performance. This systematic review evaluated the effects of sarcopenia on postoperative functional recovery and mortality in patients undergoing orthopaedic surgery and secondarily assessed the methods used to diagnose and define sarcopenia in the orthopaedic literature.
Methods
A systematic search was conducted in MEDLINE, EMBASE and Google Scholar databases according to the PRISMA guidelines. Studies involving sarcopenic patients that underwent defined orthopedic surgery and recorded postoperative outcomes were included. The quality of the criteria by which a sarcopenia diagnosis was made was evaluated. Publication quality was assessed using Newcastle-Ottawa Scale.
Results:
A total of 365 studies were identified and screened, 26 full text records were reviewed, and 19 publications included in the review. In total 3009 patients were included, of which 2146 (71%) were female and 863 (29%) were male. Mean age of the participants was 75.1yrs (SD 7.1). Five studies included patients who underwent spinal surgery, 13 included hip or knee surgery and a single article evaluated distal radius fixation. Mean follow up was 1.9 years (SD: 1.9 years). There was wide heterogeneity in measurement tools and evaluated parameters across the included papers. Sarcopenia was associated with at least one deleterious effect on surgical outcomes in all 19 studies. Post-operative mortality rate was reported in 11 papers and sarcopenia was associated with poorer survival in 73% (8/11) of these. The most commonly utilised outcome was the Barthel index (4/19), and sarcopenic patients recorded lower scores in 75% (3/4) of these. Sarcopenia was defined using the gold standard three parameters (muscle strength, muscle quantity or quality and muscle function) in 21% of studies, using two parameters in 21% studies and one in the remaining 58%. The methodological quality of included papers was moderate -high.
Conclusions
The orthopaedic literature suffers from heterogeneity in outcomes and classification of sarcopenia diagnostic parameters. However, what data exists suggests that sarcopenia impairs recovery and increases postoperative mortality, especially in the trauma setting. Further research is required to create processes for the accurate diagnosis of sarcopenia in orthopaedics, which may facilitate targeted pre-operative interventions that aim to improve outcomes
Original languageEnglish
Pages (from-to)321-330
JournalThe Bone & Joint Journal
Volume104-B
Issue number3
DOIs
Publication statusPublished - 1 Mar 2022

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