Analytic Morphomics, Core Muscle Size, and Surgical Outcomes
Analytic Morphomics, Core Muscle Size, and Surgical Outcomes
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DOI：
10.1097/sla.0b013e31826028b1
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发表时间：
2012-08-01
影响因子：
9
通讯作者：
Wang, Stewart C.
中科院分区：
文献类型：
--
作者：
Englesbe, Michael J.;Lee, Jay S.;Wang, Stewart C.
目的：评估术前横截面图像测量的瘦核心肌大小与手术结果之间的关系。背景：需要新的术前风险测量方法。分析形态学分析的横截面诊断图像可能会阐明大量的患者的具体数据，这是从来没有评估由clinics.Methods：研究人群包括密歇根州外科质量协作数据库内的所有患者的计算机断层扫描（CT）扫描之前，主要的，选择性的一般或血管手术（N = 1453）。使用分析形态学技术计算瘦核心肌肉的大小。主要结局指标是生存率，而次要结局包括手术并发症和费用。协变量调整后的结果进行了评估usingKaplan-Meier分析，多变量考克斯回归，多变量Logistic回归，和广义估计方程methods.Results：平均随访时间为2.3年，214例患者在观察期间死亡。协变量调整后的瘦核心肌面积的风险比为1.45（P = 0.028），表明瘦核心肌面积每减少1000 mm 2，死亡率增加45%。当将核心肌肉大小分为三分位数时，最小与最大三分位数的1年生存率分别为87%与95%，而3年生存率分别为75%与91%（两种比较均P < 0.003）。估计的平均并发症风险有显著差异，在瘦核心肌面积的下、中和上三分位分别为20.9%、15.0%和12.3%。核心肌尺寸每减少1000 mm 2，协变量调整成本显著增加10，110美元（P = 0.003）。结论：核心肌尺寸是一个独立的和潜在的重要术前风险因素。用于评估术前CT扫描的技术，即分析形态学，可能代表了一种更好地了解患者风险的新方法。
Objective: Assess the relationship between lean core muscle size, measured on preoperative cross-sectional images, and surgical outcomes.Background: Novel measures of preoperative risk are needed. Analytic morphomic analysis of cross-sectional diagnostic images may elucidate vast amounts of patient-specific data, which are never assessed by clinicians.Methods: The study population included all patients within the Michigan Surgical Quality Collaborative database with a computerized tomography(CT) scan before major, elective general or vascular surgery (N = 1453). The lean core muscle size was calculated using analytic morphomic techniques. The primary outcome measure was survival, whereas secondary outcomes included surgical complications and costs. Covariate adjusted outcomes were assessed usingKaplan-Meier analysis, multivariate cox regression, multivariate logistic regression, and generalized estimating equation methods.Results: The mean follow-up was 2.3 years and 214 patients died during the observation period. The covariate-adjusted hazard ratio for lean core muscle area was 1.45 (P = 0.028), indicating that mortality increased by 45% per 1000 mm(2) decrease in lean core muscle area. When stratified into tertiles of core muscle size, the 1-year survival was 87% versus 95% for the smallest versus largest tertile, whereas the 3-year survival was 75% versus 91%, respectively (P < 0.003 for both comparisons). The estimated average risk of complications significantly differed and was 20.9%, 15.0%, and 12.3% in the lower, middle, and upper tertiles of lean core muscle area, respectively. Covariate-adjusted cost increased significantly by an estimated $10,110 per 1000 mm(2) decrease in core muscle size (P = 0.003).Conclusions: Core muscle size is an independent and potentially important preoperative risk factor. The techniques used to assess preoperative CT scans, namely analytic morphomics, may represent a novel approach to better understanding patient risk.