Sarcopenia predicts postoperative infection in patients undergoing hepato-biliary-pancreatic surgery

Background Operative mortality and morbidity rates after hepato-biliary-pancreatic (BILI) surgery remain high. This study evaluated clinical characteristics and surgical outcomes of patients who underwent BILI surgery and investigated predictors of outcomes by focusing on sarcopenia. Materials and methods A prospective observational study was performed for consecutive patients who underwent BILI surgery at our institution between June 2013 and May 2014. Sarcopenia was evaluated using computed tomography. Surgical outcomes and the influence of sarcopenia on outcomes were evaluated. Subsequently, the impact of prognostic factors, including sarcopenia, associated with postoperative infections was assessed using multivariate analyses. Results Total mortality, major complications, and infectious disease rates for all 157 patients were 0%, 9.6%, and 21.7%, respectively. Thirty-eight patients met the criteria for sarcopenia. The sarcopenic group had a significantly higher incidence of infectious complications compared to the non-sarcopenic group (36.8% vs. 17.2%; P = 0.015). During multivariate analyses of prognostic factors, sarcopenia (hazard ratio = 2.44; P = 0.043) and diabetes mellitus (hazard ratio = 3.07; P = 0.01) were detected as independent predictors of postoperative infections. Conclusions Sarcopenia is an independent preoperative predictor of infection after BILI surgery. Earlier diagnosis and therapeutic intervention for patients with sarcopenia could be useful in the development of comprehensive approaches for perioperative care.