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Sarcopenia effect on mortality and spinal cord ischemia after complex aortic aneurysm repair A systematic review and meta-analysis

Published:January 15, 2023DOI:https://doi.org/10.1016/j.ejvs.2023.01.008
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      Abstract

      Objectives

      Sarcopenia has been related to higher mortality after abdominal aortic aneurysm repair. This analysis aimed to assess sarcopenia-related mortality and spinal cord ischemia (SCI) at 30 days, and mortality during the available follow-up, in patients managed for complex aortic aneurysms, with open or endovascular intervention.

      Design

      This meta-analysis was conducted according to PRISMA and pre-registered to PROSPERO (CRD42022338079). A search of the English literature, via Ovid, using MEDLINE, EMBASE, and CENTRAL databases, until 15th June 2022, was accomplished.

      Materials

      Observational studies (2000-2022), with ≥5 patients, reporting on sarcopenia-related mortality and SCI at 30-days, and mid-term mortality after thoraco-abdominal aneurysm repair (open or endovascular), were eligible.

      Methods

      The ROBINS-I tool was used for risk of bias and GRADE for evidence quality assessment. The primary outcome was 30-day and mid-term mortality and secondary was SCI at 30-days, in sarcopenic and non-sarcopenic patients. The outcomes were summarized as odds ratio (OR) with 95% confidence intervals (CI).

      Results

      Four retrospective studies [1,092 patients; 40.0% sarcopenic] were included. Thirty-day mortality was similar, with low certainty, between groups [6% (95% CI, 1-11%) in sarcopenic vs 5% (95% CI, 1-9%) in non-sarcopenic; OR, 0.30; 95% CI, -0.21, 0.81; p=.94, Ι2=0%]. The estimated mid-term mortality was significantly higher (very low certainty) among sarcopenic patients [25% (95% CI 0.19, 0.31%) in sarcopenic vs. 13% in non-sarcopenic (95% CI -0.03, 0.29%); 1.11 OR, 0.95; 95% CI, -0.21, 2.44; p<.001, Ι2=88.32%]. SCI was significantly higher (very low certainty) in sarcopenic patients [19%; 95% CI 4-34%) vs. 7% (95% CI, 5-20%) in non-sarcopenic; OR, 1.80; 95% CI, -0.17, 3.78, Ι2=82.4%], despite the equal distribution of aneurysm type between groups.

      Conclusion

      Early mortality seemed not to be affected by sarcopenia in patients treated for thoraco-abdominal aneurysms. However, it may be associated with higher peri-operative SCI and mid-term mortality rates.

      Keywords

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