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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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Article info
Publication history
Accepted:
January 11,
2023
Received in revised form:
December 21,
2022
Received:
July 27,
2022
Publication stage
In Press Accepted ManuscriptIdentification
Copyright
© 2023 European Society for Vascular Surgery. Published by Elsevier B.V. All rights reserved.
