Sarcopenia as a Predictor for Major Postoperative Complications in Patients With IBD: A Systematic Review and Meta-Analysis

Introduction: Sarcopenia has been increasingly reported as a cause of morbidity and mortality. Additionally, sarcopenia is significantly prevalent among patients with inflammatory bowel disease (IBD). We conducted a systematic review and meta-analysis to assess the association between sarcopenia and postsurgical outcomes in patients with IBD. Methods: We systematically searched PubMed, Ovid, Medline, Cochrane, and Trip databases, last updated November 2022. We also performed a manual search of the relevant articles’ references. We included studies comparing major postoperative complications (>III Clavien-Dindo classification) in IBD patients with sarcopenia and those without. Sarcopenia was defined by measuring psoas muscle mass on CT imaging. Inverse-variance method was used to calculate the weighted pooled odds ratio under the random effect model. Results: Initial search identified 744 studies, of which 69 relevant articles were selected and reviewed. Five studies met our inclusion criteria, characteristics of each study in Table 1. All the studies included were published in English in full-text form, and were retrospective analyses of prospectively maintained data. A total of 746 were included in this meta-analysis. Of these patients, 639 patients had Crohn's disease (CD) (85%), 103 had ulcerative colitis (UC) (14%), and four patients had indeterminate IBD (< 1%). The sarcopenic cohort included 359 (48%) patients, while 387 (52%) patients were in the nonsarcopenic group. Major bowel resection was performed in 71% (531), minor surgeries in 5% (37), and 24% of the surgeries (178) were not reported. While 32% (244) of them were laparoscopic, 45% (338) were open, and 23% (178) were not specified. The analysis showed a significant increase in the odds of major postsurgical complications in patients with IBD who had concomitant sarcopenia compared to those without sarcopenia (OR=2.67; 95% CI 1.96–3.65). Moderate heterogeneity was observed in the analyses (I2=52%, P=0.08; Figure 1). Conclusion: Sarcopenia is a major modifiable risk factor for postoperative complications in IBD patients. Preoperative assessment of muscle mass by cross-sectional imaging can help stratify the risks of surgery and facilitates adjustments to treatment and nutritional satus to improve outcomes. Further longitudinal studies that recruit both UC and CD patients and use a unified detailed definition of sarcopenia that considers sex and BMI are needed.Figure 1.: Forest Plot. Table 1. - Author Year Country Size Type of IBD CD/UC Definition of sarcopenia Sarc/Non Type of surgery Zangh 2017 China 114 CD 114/0 SMI < 55 cm2/m2 for men<39 cm2/m2 for women) 70/44 bowel resection Pederson 2017 USA 178 Mixed 127/51 TPI or mean HUAC within the lowest sex quartile at the level of the third lumbar vertebral body 44/134 major abdominal surgeries exclusive of diversions or ostomy reversals O'Brien 2018 Ireland 77 Mixed 52/21 SMI < 43 cm2/ m2 in men< 41 cm2/m2 in women, 30/47 colonic resection Galata 2020 Germany 230 CD 230/0 SMI of < 43 cm2/m2 for males with BMI < 25 kg/m2, < 53 cm2/m2 for males with BMI & 25 kg/m2 , and < 41 cm2 /m2 for females 162/68 Intestinal surgery Trinder 2022 Australia 147 Mixed 116/31 SMI 52.4 and 38.5 cm2/m2 for men and women 53/94 major abdominal surgery Sarc: Sarcopenia, Non: Non-Sarcopenia, SMI: Skeletal Muscle Index, TPI: Total Psoas Index, HUAC: Hounsfield unit average calculation.