Impact of sarcopenia on postoperative outcomes and recurrence in patients with Crohn disease: A retrospective cohort study

Crohn disease (CD) is a chronic inflammatory bowel disease and is associated with malnutrition. Sarcopenia is an indicator of poor nutrition status. This study evaluated the impact of preoperative and postoperative sarcopenia on postoperative outcomes including complications and recurrence. This single-center, retrospective study included patients who underwent abdominal surgery for CD between January 2006 and December 2016. This study analyzed the data using abdominal computed tomography (CT) images at the inferior endplate level of the third lumbar vertebra taken within 1 month before surgery. The skeletal muscle index (SMI) was calculated as total abdominal muscle area (TAMA)/height2 and sarcopenia was defined as an SMI of ≤49.0 cm2/m2 for men and ≤31.0 cm2/m2 for women using Korean-specific cutoff value. Of the 569 patients enrolled, 412 patients (72.4%) had preoperative sarcopenia (sarcopenia group, SG) and 157 patients (27.6%) were within the normal range (non-sarcopenia group, NSG). The SG had significantly younger age at diagnosis, a higher proportion of male patients, and a lower mean BMI compared with the NSG. On multivariable analysis, preoperative sarcopenia was an independent risk factor for postoperative complications (relative risk [RR] = 1.88, 95% confidence interval [CI]: 1.00-3.53; P = .049). Checking the change of postoperative sarcopenia using the follow-up CT, 240 patients (58.2%) of the SG still showed sarcopenia (post-SG) and 154 patients (37.4%) recovered from sarcopenia (post-NSG). The post-SG had significantly lower 5-year surgical recurrence-free survival, compared with the post-NSG (88.7% ± 2.1% vs 93.8% ± 1.5%, P = .019). More than 70% of patients with CD undergoing intestinal surgery had preoperative sarcopenia. Preoperative sarcopenia was an independent risk factor for postoperative complications, and persistent postoperative sarcopenia was associated with surgical recurrence. Sarcopenia assessment may be a useful tool for risk stratification in surgical CD patients.