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Is sarcopenia a risk factor for reduced diaphragm function following hepatic resection? A study protocol for a prospective observational study. | LitMetric

AI Article Synopsis

  • Sarcopenia, or muscle wasting, is linked to lower lung function and a higher risk of pneumonia after abdominal surgery, which can lead to longer hospital stays and increased mortality.
  • The study aims to investigate how sarcopenia affects diaphragm function in patients undergoing major liver surgery, specifically comparing sarcopenic to non-sarcopenic patients in terms of preoperative diaphragm function and postoperative recovery.
  • A variety of imaging techniques, including ultrasound and spirometry, will be utilized to assess diaphragm and muscle function in both groups of patients before and after the surgery.

Article Abstract

Introduction: Sarcopenia is associated with reduced pulmonary function in healthy adults, as well as with increased risk of pneumonia following abdominal surgery. Consequentially, postoperative pneumonia prolongs hospital admission, and increases in-hospital mortality following a range of surgical interventions. Little is known about the function of the diaphragm in the context of sarcopenia and wasting disorders or how its function is influenced by abdominal surgery. Liver surgery induces reactive pleural effusion in most patients, compromising postoperative pulmonary function. We hypothesise that both major hepatic resection and sarcopenia have a measurable impact on diaphragm function. Furthermore, we hypothesise that sarcopenia is associated with reduced preoperative diaphragm function, and that patients with reduced preoperative diaphragm function show a greater decline and reduced recovery of diaphragm function following major hepatic resection. The primary goal of this study is to evaluate whether sarcopenic patients have a reduced diaphragm function prior to major liver resection compared with non-sarcopenic patients, and to evaluate whether sarcopenic patients show a greater reduction in respiratory muscle function following major liver resection when compared with non-sarcopenic patients.

Methods And Analysis: Transcostal B-mode, M-mode ultrasound and speckle tracking imaging will be used to assess diaphragm function perioperatively in 33 sarcopenic and 33 non-sarcopenic patients undergoing right-sided hemihepatectomy starting 1 day prior to surgery and up to 30 days after surgery. In addition, rectus abdominis and quadriceps femoris muscles thickness will be measured using ultrasound to measure sarcopenia, and pulmonary function will be measured using a hand-held bedside spirometer. Muscle mass will be determined preoperatively using CT-muscle volumetry of abdominal muscle and adipose tissue at the third lumbar vertebra level (L3). Muscle function will be assessed using handgrip strength and physical condition will be measured with a short physical performance battery . A rectus abdominis muscle biopsy will be taken intraoperatively to measure proteolytic and mitochondrial activity as well as inflammation and redox status. Systemic inflammation and sarcopenia biomarkers will be assessed in serum acquired perioperatively.

Ethics And Dissemination: This trial is open for recruitment. The protocol was approved by the official Independent Medical Ethical Committee at Uniklinik (Rheinish Westphälische Technische Hochschule (RWTH) Aachen (reference EK309-18) in July 2019. Results will be published via international peer-reviewed journals and the findings of the study will be communicated using a comprehensive dissemination strategy aimed at healthcare professionals and patients.

Trial Registration Number: ClinicalTrials. gov (EK309-18); Pre-results.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8596026PMC
http://dx.doi.org/10.1136/bmjopen-2021-053148DOI Listing

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