Sarcopenia as a Factor Associated with Surgical Site Infection: A Narrative Literature Review

• DOI: https://doi.org/10.22533/at.ed.51572142603079

• Palavras-chave: sarcopenia; surgical site infection; surgical wound infection; postoperative complications; surgery.

• Keywords: sarcopenia; surgical site infection; surgical wound infection; postoperative complications; surgery.

• Abstract:

  Introduction: Sarcopenia, characterized by a progressive reduction in muscle mass and function, has been associated with worse outcomes in various surgical settings. Among these outcomes, surgical site infection and other postoperative infections represent significant complications, as they increase morbidity, length of hospital stay, hospital costs, and the risk of delays in adjuvant treatment for cancer patients. Although several studies have investigated the association between sarcopenia and surgical complications, the results regarding surgical wound infection and surgical site infection remain heterogeneous.
  Objective: To review the selected literature on the association between sarcopenia and surgical site infection or surgical wound infection in patients undergoing surgical procedures.
  Methods: A narrative literature review was conducted based exclusively on the articles provided for this review. Studies were included that assessed sarcopenia, low muscle mass, poor muscle quality, the psoas index, the skeletal muscle index, radiological sarcopenia, or laboratory indices associated with muscle mass, in association with surgical site infection, postoperative infectious complications, deep-seated infection, or surgical wound complications. Studies across different surgical specialties were considered, with an emphasis on the prognostic association between sarcopenia and infection.
  Results: Most of the included observational studies suggested an association between sarcopenia or poor muscle quality and an increased risk of surgical site infection or postoperative infectious complications. This association was described in colorectal cancer resection, gastrectomy, restorative proctocolectomy for ulcerative colitis, pancreaticoduodenectomy, Hartmann’s reversal, and flap reconstruction following oral cancer resection. However, some studies found no significant association, including a cohort of colorectal cancer surgery, a systematic review on ventral hernia repair, orthopedic surgery for open tibia/ankle fractures, and sacral tumor resection. The heterogeneity of the findings appears to reflect differences in the type of surgery, definition of sarcopenia, measurement method, body composition, definition of infection, and sample size.
  Conclusion: Sarcopenia appears to be a significant marker of surgical vulnerability and may be associated with an increased risk of surgical site infection or infectious complications in certain surgical contexts, particularly in complex abdominal, oncologic, or reconstructive surgeries, or in surgeries performed on patients with a higher inflammatory and nutritional burden. However, this association is not consistent across all procedures, and the literature still has significant methodological limitations.   The   identification   preoperative   of   sarcopenia   may   contribute   to risk stratification, patient counseling, nutritional optimization, prehabilitation, and individualized perioperative planning.