Effects of sarcopenia and frailty on postoperative recovery in elderly patients: A prospective cohort study

Abstract Background Sarcopenia and frailty are both age‐related declines in functional reserve that are linked to adverse health outcomes. It is critical to know about the outcomes of a combination of these conditions. The study aimed to investigate the effects of sarcopenia and frailty on postoperative recovery in elderly patients and to explore risk factors. Methods This prospective cohort study was conducted among 608 patients aged ≥60 years, American Society of Anesthesiologists I‐III, who were scheduled to undergo thoracic (non‐cardiac) and abdominal surgery from 1 March 2022 to 31 October 2022 at the Affiliated Hospital of Xuzhou Medical University. Frailty was measured by the 28‐item frailty index, and sarcopenia was assessed sarcopenia was assessed by skeletal muscle index in computed tomographic scan, handgrip strength and 6‐m walk. Participants were classified as follows: Group A: both sarcopenia and frailty; Group B: sarcopenia only; Group C: frailty only; and Group D: neither frailty nor sarcopenia. The primary outcome was 90‐day morbidity. Multivariable logistic regression model was used to estimate the association between sarcopenia, frailty and 90‐day morbidity. Results The median (interquartile range) age of participants was 68 (64–72) years, and 62.7% were men. The prevalence rates of sarcopenia and frailty were 32.8% and 47.6%, respectively. The 90‐day morbidity in Group A was 58.5%, in Group B was 46.2%, in Group C was 42.0% and in Group D was 28.8%, and the difference was significant ( P < 0.001). In the multivariable analysis, both sarcopenia and frailty [odds ratio (OR), 2.21; 95% confidence interval (CI), 1.26–3.89], sarcopenia only (OR, 1.84; 95% CI, 1.01–3.36), frailty only (OR, 1.77; 95% CI, 1.03–3.03), women (OR, 0.67; 95% CI, 0.45–0.99), body mass index (OR, 0.94; 95% CI, 0.88–0.99), pre‐operative albumin (OR, 0.96; 95% CI, 0.91–1.00) and operative stress score (OSS) [OSS 3 (OR, 2.09; 95% CI, 1.21–3.67); OSS 4–5 (OR, 3.81; 95% CI, 2.31–6.42)] were independently associated with 90‐day morbidity. In the multivariable analysis with inverse probability weighting adjusted cohort, sarcopenia and frailty were also significantly associated with 90‐day morbidity. Conclusions Sarcopenia and frailty were associated with higher risks of postoperative 90‐day morbidity in elderly patients alone and in combination. Sex, body mass index, pre‐operative albumin and operative stress were also independent factors for postoperative morbidity within 90 days.