Sarcopenic obesity and post‐operative morbidity after pancreatic surgery: a cohort study

Background Several indices of sarcopenia (SARC) exist in the literature, however, there is no consensus as to the best SARC index to predict post‐operative morbidity following pancreatic surgery. Methods A prospectively collected database was reviewed in a single institution including a total of 89 consecutive patients who had undergone pancreatic resection between 2015 and 2018. Results A total of 89 patients comprised the cohort. Seventy‐one percent (63/89) underwent pancreaticoduodenectomy. SARC was identified in 49 patients (55%) using psoas muscle index, 44 patients (49%) using the skeletal muscle index and 25 patients (28%) using the skeletal muscle attenuation. Post‐operative morbidity did not differ between SARC and non‐SARC (NSARC) patients using all three preoperative computed tomography measures (skeletal muscle index SARC 64%, 28/44, NSARC 64%, 29/45, P = 1.000; psoas muscle index SARC 63%, 31/49, NSARC 65%, 26/40, P = 0.810; skeletal muscle attenuation SARC 17/25, NSARC 40/64, P = 0.247). However, sarcopenic obesity was a significant independent risk factor for overall post‐operative morbidity on multivariate analysis (odds ratio 1.241 (SE 0.608), P = 0.041) with the highest specificity (81%). Conclusion Preoperative sarcopenic obesity can be an important independent predictor of post‐operative morbidity following pancreatic resection. There remains a need for standardization of SARC indices.