Prevalence of Sarcopenia in Children Undergoing Total Pancreatectomy with Islet Autotransplantation (TPIAT) and Implications for Short-Term Surgical Outcomes

INTRODUCTION: Sarcopenia, the loss of muscle mass and function, is a measure of frailty that is correlated with perioperative morbidity in patients with chronic illness and transplant. We sought to understand the prevalence of sarcopenia in our pediatric population undergoing total pancreatectomy with islet cell autotransplantation (TPIAT) and how sarcopenia impacts short-term postsurgical outcomes. METHODS: This was a single-center, IRB-approved study of children (1-18.99 y) who underwent TPIAT at our institution. Patients were identified from a prospective registry where clinical data (pain assessments, 30-day postoperative outcomes) were available near the time of surgery. Sarcopenia was assessed via retrospective analysis of cross-sectional imaging using segmentations of the psoas muscle and total abdominal skeletal muscle. Z-scores (<-1.6) calculated using established normal values defined sarcopenia. Change in muscle mass over time was also determined. RESULTS: In our cohort, 32.4% (22/68) of patients were sarcopenic at the time of TPIAT by psoas muscle but only 7.4% (6/81) were sarcopenic by total abdominal skeletal muscle. There was no significant difference in primary outcomes (30-day readmissions, reoperations, and complications; and the number of days spent inpatient after surgery) based on sarcopenia or decreasing muscle mass. There was a statistically significant association between psoas-determined sarcopenia and higher frequency of pain before TPIAT (P=0.016). CONCLUSIONS: Sarcopenia was 32.4% prevalent by psoas muscle measurement but was less prevalent by total abdominal skeletal muscle measurement in children undergoing TPIAT. There was no relationship between the presence of sarcopenia or decreasing muscle mass and 30-day postoperative outcomes but there was a positive association between higher frequency of pre-operative pain and sarcopenia.