Skip to main content
Download PDF

Effects of sarcopenia on postoperative recovery in elderly patients after cardiac surgery with cardiopulmonary bypass

BMC Geriatrics volume 25, Article number: 295 (2025) Cite this article

Abstract

Background

Few studies have assessed sarcopenia identified by erector spinae muscle (ESM) using thoracic computed tomography (CT) before cardiac surgery. We aimed to explore the relationship between sarcopenia evaluated via ESM and poor outcomes following cardiac surgery with cardiopulmonary bypass (CPB) in elderly patients.

Methods

268 patients older than 65 years who underwent cardiac surgery with CPB at our institution in 2020 were included in the retrospective, single center, cohort study. Preoperative chest CT scans were used to measure the cross-sectional areas of the ESM (ESMCSA), which were then adjusted for body surface area (BSA) to determine the muscle mass index. Patients were categorized into sarcopenia and non-sarcopenia groups based on ESMCSA/BSA scores, and their short- and long-term clinical outcomes were compared.

Results

The ESMCSA/BSA detected sarcopenia in 51.1% of patients. Patients with sarcopenia had significantly extended durations of stay in both the intensive care unit and the hospital compared to those without sarcopenia. Furthermore, the incidence of major adverse events was significantly higher in the sarcopenia group compared to the non-sarcopenia group (15.3% vs. 32.1%, P < 0.001). Furthermore, multivariate logistic regression analysis demonstrated that sarcopenia (OR 2.457, 95% CI 1.178–5.126, P = 0.017) independently predicted the risk of postoperative complications after adjusting for gender, preoperative nutritional status, serum albumin, estimated glomerular filtration rate, creatinine, white blood cell count, lymphocytes, type of surgery, surgical time, and aortic cross-clamp time. Kaplan–Meier survival analysis revealed a statistically significant difference in overall mortality between groups (log-rank P = 0.011). The Cox proportional hazards model identified preoperative sarcopenia as an independent risk factor for long-term mortality (HR, 2.132; 95% CI 1.144–3.972, P = 0.017).

Conclusion

Our study identified preoperative sarcopenia, assessed via ESM muscle mass on chest CT, as an independent predictor of postoperative complications and long-term overall mortality in elderly cardiac surgery patients with CPB.

Peer Review reports

Introduction

Cardiovascular diseases (CVD) continue to be the number one cause of death and disability [1]. As the global population ages, elderly individuals represent a growing segment of those undergoing cardiac open-heart surgery with cardiopulmonary bypass (CPB). Comorbidities in geriatric individuals contribute to greater complexity and a higher risk of surgery [2]. Sarcopenia is a syndrome marked by the age-related reduction in skeletal muscle mass, strength, and physical activity [3]. Muscle loss typically begins at around 50 years of age and declines at a rate of approximately 0.8% per year [4]. Sarcopenia has recently been identified as both a consequence of aging and an indicator of frailty. Growing evidence indicates that sarcopenia significantly increases adverse consequences, exacerbates functional decline and elevates mortality rates after cardiac surgery [5, 6].

Postoperative recovery in cardiac surgery is complex and involves multiple factors, including preparation before the operation, care after the surgery, and the patient’s physical and mental state. Recently, the focus on enhanced recovery after cardiac surgery has intensified, notably after its success in colorectal operations was confirmed [7]. Elderly Patients with CPB facing greater physical and psychological pressure are more likely to experience postoperative complications and increased operative mortality [8]. Comprehensive assessment of individuals and identification of risk factors prior to surgery is recognized for improving survival and outcomes in elderly patients following cardiac surgery [9]. Notably, sarcopenia is identified as an important target of preoperative intervention [10, 11]. It has been shown that preoperative physical activity for older patients with gastric cancer can substantially strengthen hand grip, thereby improving their postoperative recovery [12].

Despite many studies regarding adverse health outcomes for sarcopenic patients, there are no single diagnostic criteria available for sarcopenia and various parameters and tools have been used, such as muscle mass, muscle strength, and gait speed measurements [13]. Regarding cardiac surgery, the published research exploring sarcopenia on prognosis mainly focused on lumbar skeletal muscle quality assessed by perioperative abdominal computed tomography (CT) [14]. Lee and colleagues identified sarcopenia, determined by the cross-sectional area (CSA) of skeletal muscle at the third lumbar vertebra (L3), as a risk factor for adverse short- and long-term outcomes following surgical aortic valve replacement [15]. Kiriya et al. and Okamura et al. both demonstrated that patients with sarcopenia, as assessed by CSA at the L3 vertebra using perioperative abdominal CT, exhibited higher complication rates [16, 17].

Perioperative chest CT is routine for patients undergoing cardiac surgery rather than abdominal CT. Limited studies have evaluated sarcopenia using skeletal muscle metrics from chest CT prior to cardiac surgery and yielded inconsistent results [18, 19]. Furthermore, the effect of sarcopenia determined by erector spinae muscle (ESM) mass on clinical outcomes in elderly cardiac surgery patients is not yet well understood. Therefore, we aimed to evaluate the predictive value of preoperative sarcopenia defined by ESM mass on the outcomes after cardiac surgery with CPB in older patients.

Methods and materials

Study population

We conducted a retrospective review of data from patients over 65 years who underwent open cardiac surgery with CPB at our center in 2020. The study protocol received approval from the Hospital Clinical Research Ethics Committee (no.2022-216-01), with informed consent requirements waived. Those patients who diagnosed with aortic dissection, without preoperative thoracic CT scan, with significantly impaired liver or renal function, or without complete preoperative laboratory were excluded. Finally, 268 patients were enrolled in this study (Fig. 1). All the demographic, clinical, biochemical and surgical data were retrospectively collected from electronic medical records.

Fig. 1
figure 1

Flow chart of patient selection and classification

Full size image

The preoperative nutritional status was assessed using the CONUT scoring system, which is derived by summing up the score of serum albumin score (0, ≥ 3.5 g/dL; 2, 3.0–3.49 g/dL; 4, 2.50–2.99 g/dL; and 6, < 2.50 g/dL), total cholesterol score (0, ≥ 180 mg/dL; 1,140-179 mg/dL; 2, 100-139 mg/dL; and 3, < 100 mg/dL), and lymphocyte counts score (0, ≥ 1600/µL; 1, 1200–1599/µL; 2, 800–1199/µL; and 3, < 800/µL) [20]. Patients with the CONUT score of 2 or higher were considered to be at nutritional risk.

Definition of sarcopenia

The measurement of muscle area via CT scans is regarded as the most reliable method for evaluating muscle mass in the elderly [21]. In this study, we utilized sliceOmatic software V5.0 (TomoVision) to measure the total bilateral ESM area (cm2) at the level of the 12th thoracic vertebra (Th12) on axial cross-sectional CT images (Fig. 2). Cross-sectional areas of the ESM (ESMCSA) were quantified based on well-established thresholds from − 29 to + 150 Hounsfield units (HU), and adjusted to body surface area (BSA) [22,23,24]. We stratified patients into sarcopenia or non-sarcopenia groups according to the ESACSA/BSA cut-off of 17.2 cm2/m2 [22, 24]. Additionally, the muscle density (MD) was assessed through the mean radiographic density (HU) of ESM, serving as an indicator of skeletal muscle quality [25].

Fig. 2
figure 2

Total ESM area (cm2) at the 12th thoracic vertebra based on preoperative thoracic CT

Full size image

Study outcomes

The primary outcome was a composite of major in-hospital complications following open cardiac surgery with CPB, which included (1) infection-related complications, such as pneumonia, bacteremia and wound infection; (2) cerebrovascular accident (CVA); (3) new onset of atrial fibrillation; (4) acute kidney injury (AKI); (5) gastrointestinal bleeding; (6) delirium; (7) ECMO support; (8) pleural effusion; (9) readmission to the ICU. All the above post-operative complications were assessed by attending physician or specialist on the basis of the medical history, physical examination, laboratory data and radiographic findings. Furthermore, the information of lengths of stay (ICU, hospital), hospital mortality and mechanical ventilation duration were also collected. Besides, long-term clinical outcome focused on all-cause mortality, with a median follow-up duration of 49.5 months by July 2024.

Sample size calculation

We calculated the required sample size for two survival curves using Cox proportional hazards model. Power, Analysis and Sample Size (V.11.0) was used for sample size calculation. According to a study with the medium follow-up was 3.4 years, the all-cause mortality of sarcopenia defined as the lowest sex-specific quartile in psoas muscle area and non-sarcopenia group in older patients who underwent heart valve surgery is about 28% and 9% respectively [17]. When the hazard ratio is 2.221 with 80% probability (type II error probability 0.2), at an α-level (type I error probability) of 0.05, 267 subjects (133 in the control group and 134 in the sarcopenia group) would be required.

Statistical analyses

Patients were categorized to sarcopenia and non-sarcopenia group according to ESACSA/BSA value. All data are presented as absolute frequencies (percent), mean with standard deviations, or medians with interquartile ranges (IQR). Baseline characteristics and clinical outcomes between groups were compared using appropriate statistical tests, including Student’s t-tests, Wilcoxon rank sum tests, χ2 tests, or Fisher’s exact tests. We employed univariable and multivariable logistic regression analyses to examine the association between preoperative sarcopenia and increased morbidity of postoperative complications. Collinearity diagnostics were assessed to look for multi-collinearity between covariates with a P-value < 0.05 from the univariate analysis. Finally, CPB time was excluded, leaving gender, CONUT score, preoperative serum albumin, creatinine, eGFR, white blood cell count, lymphocytes, type of surgery, surgical time, and aortic cross-clamp time for the multivariable logistic regression analyses. A Kaplan-Meier curve was plotted to compare the survival difference between groups, with comparisons made using the log-rank test. Then, we selected these confounders in the multivariable Cox regression analysis on the basis of their significant associations with the mortality or a change in effect estimate of sarcopenia on mortality more than 10% [26]. Statistical evaluation of the data was performed with IBM SPSS 22.0 and MedCalc software 15.2.2 and Empower software 6.0. Analyses were two-sided, with statistical significance set at a P-value < 0.05.

Results

Patients and characteristics

Table 1 shows the baseline characteristics of patients categorized according to ESACSA/BSA cutoff value. Among the 268 patients (mean age 72 ± 5 years, 118 men and 150 women), 137 (51.1%) were classified as sarcopenic, while 131 (48.9%) were non-sarcopenic. Sarcopenic patients were predominantly female and had a lower body mass index compared to non-sarcopenic patients. No significant differences were found in the prevalence of comorbid conditions, except for hypertension. Furthermore, preoperative laboratory tests, CONUT scores, and surgery types showed no significant differences. However, we found that sarcopenic patients had longer CPB time and aortic cross-clamp time (all P < 0.05). As predicted, individuals in the sarcopenic group exhibited lower ESMCSA, mean radiographic density of the erector spinae muscles (ESMCT) and ESMCSA/BSA among the CT muscle parameters (all P < 0.001).

Table 1 Baseline characteristics of study patients
Full size table

Comparison of early adverse events

As shown in Table 2, there were 4 (1.5%) in-hospital deaths and 64 (23.9%) in-hospital major complications. The groups differed in the morbidity of postoperative complications (32.1% vs. 15.3%, P < 0.001). The sarcopenia group exhibited significantly higher incidences of pneumonia (13.1% vs. 6.1%, P < 0.001), wound infection (2.9% vs. 0%, P = 0.020), acute kidney injury (AKI) (8.8% vs. 3.1%, P = 0.044), pleural effusion (13.1% vs. 5.3%, P = 0.028), and ICU readmission (8.0% vs. 2.3%, P = 0.035) compared to the non-sarcopenia group. Besides, sarcopenia patients had longer ICU stay (2 vs. 3 d, P = 0.012) and hospital stay (21 vs. 22 d, P = 0.047). Sarcopenia patients experienced extended ICU stays (2 vs. 3 days, P = 0.012) and longer hospital stays (21 vs. 22 days, P = 0.047).

Table 2 Comparison of short-term surgical results of the patients
Full size table

Risk factor analysis for postoperative complications

Table 3 displays the regression analysis results for risk factors associated with postoperative complications. Univariate regression analysis identified associations between postoperative complications and several factors, including gender, CONUT ≥ 2, serum albumin, creatinine, eGFR, count of white blood cell and lymphocytes, type of surgery, surgical time, aortic cross-clamp time, and sarcopenia. When all the above mentioned variables were included in a multiple model, sarcopenia was statistically significant with OR of 2.626 (95% CI 1.447–4.766, P = 0.002) in the univariate analysis and OR 2.457 (95% CI 1.178–5.126, P = 0.017) in the multivariable analysis.

Table 3 Prognostic utility of sarcopenia in predicting postoperative complications
Full size table

Survival analysis

Median follow-up time was 49.5 months. 4 died during hospitalization, and 45 deaths occurred during follow-up period. The survival analysis results are depicted in Fig. 3. The median survival time of non-sarcopenia group was 1524 days, whereas the sarcopenia group was 1372 days. Kaplan-Meier curves demonstrate that patients with sarcopenia had worse overall survival than those without sarcopenia (log-rank P = 0.011). These covariates (age, gender, preoperative serum albumin, preoperative creatinine, lymphocytes cell count, surgical time, CPB time, aortic cross-clamp time, sarcopenia) showed a univariable association with all-cause mortality. Finally, gender, aortic cross-clamp time, preoperative albumin levels and sarcopenia were incorporated into the multivariate Cox regression analysis (Table 4). The results of the multivariable Cox regression model indicated that sarcopenia (HR, 2.132; 95% CI, 1.144–3.972) was an independent risk factor for mortality, along with male sex, albumin levels, and aortic cross-clamp time.

Fig. 3
figure 3

Kaplan-Meier curves for overall survival in patients with and without sarcopenia

Full size image
Table 4 Cox regression analysis of the independent risk factors for long-term mortality
Full size table

Discussion

According to the study, the major finding is that patients aged 65 and older with sarcopenia evaluated by ESM based on preoperative thoracic CT had poorer outcomes in terms of postoperative complications and long-term mortality after open cardiac surgery with CPB compared to those without sarcopenia. After adjusting for confounding factors, sarcopenia independently increased the risk of postoperative complications and long-term mortality. This study is the first to report the link between sarcopenia, as assessed by T12-ESA on thoracic CT, and clinical outcomes in elderly patients undergoing cardiac surgery with CPB.

Sarcopenia is viewed as a complicated geriatric syndrome associated with ageing and multiple diseases, potentially leading to negative health outcomes [27]. The researchers propose various indicators for assessing muscle mass and function, including grip strength, physical performance, the five-time chair stand test, and muscle mass evaluation via bioimpedance or dual-energy X-ray absorptiometry. While the five-item questionnaire and physical performance tests are simple and feasible, the expense of testing all candidates might surpass the advantages. Almost all patients routinely received a chest CT scan as part of their diagnostic work-up, so assessing sarcopenia via chest CT would have a cost-effectiveness advantage and decrease patient effort.

Recently, sarcopenia in cardiac surgery patients has started to attract more attention [28, 29]. Research indicates a strong link between sarcopenia and negative outcomes following cardiac surgery, such as postoperative complications and higher mortality rates [5, 15, 30]. In cardiac surgery research, studies on sarcopenia’s prognostic impact have mainly focused on assessing lumbar skeletal muscle quality through perioperative abdominal CT scans. To date, only a limited number of studies have employed chest CT to measure skeletal muscle quantity or quality for assessing sarcopenia prior to cardiac surgery, with findings that are not consistent. A study on pediatric patients undergoing total correction of tetralogy of Fallot found that preoperative sarcopenia, measured by the combined CSA of the pectoralis and erector spinae muscles divided by BSA from chest CT scans, did not predict early postoperative major adverse events [18]. However, a previous study involving 189 patients over 70 years old who underwent cardiac surgery via median sternotomy found that preoperative sarcopenia, as indicated by the CSA of the pectoralis muscle, was linked to reduced mid-term survival [31]. In terms of postoperative complications, Jimi and his team demonstrated that sarcopenia, characterized by the sum of PM index and ESM index below the 50th percentile for each sex, had a significant connection with 30-day postoperative complications in patients receiving isolated tricuspid valve surgery [19]. The inconsistent results in these studies may be due to different diagnostic indicators for sarcopenia.

Sarcopenia, assessed via ESM, was more prevalent in respiratory diseases like COVID-19, lung transplant, chronic obstructive pulmonary disease and lung cancer [32,33,34]. There is still no research on the sarcopenia assessed only by ESA based on chest CT after cardiac surgery. In our study, sarcopenia was defined as ESACSA/BSA < 17.2 cm2/m2 at the Th12 level, based on prior researches. Our data indicate that sarcopenia, as determined by ESM, independently predicts postoperative complications and long-term mortality following cardiac surgery. Liu et al. found that thoracic sarcopaenia, characterized by muscle tissue at the Th12 level (including ESM), was independently linked to increased postoperative complications and long-term mortality in cardiac valve surgery patients [35]. The ESM serves as an antigravity muscle and indicates physical activity. Moreover, ESM showed the strongest correlation with frailty status in older adults, surpassing the iliopsoas, rectus abdominis, and abdominal oblique muscles [36]. These findings indicate that the reduction in erector spinae muscle mass serve as a predictor of negative health outcomes in older adults. Notably, the Cox proportional hazards model identified male sex as an independent risk factor for mortality. Several studies have highlighted the importance of sex in predicting outcomes for patients undergoing cardiac surgery. Although sex does not consistently influence the survival, the male gender is frequently identified as a risk factor for long-term survival [37, 38].

This study has some limitations that should be considered. The primary issue is that the limited sample size from a single-center study constrains the applicability of the results to other countries and populations. Second, the study excluded seventy-six patients due to the absence of preoperative CT data, potentially introducing selection bias. Additionally, in this study, sarcopenia was defined solely by low muscle mass to simplify diagnosis and clinical use. Furthermore, it is important to exercise caution when using our sarcopenia cut-off value for patients of varying ages, given that patients in our cohort are older than 65.

Conclusions

Our study demonstrated that sarcopaenia defined by muscle mass of ESM based on chest CT was an independent risk factor a higher incidence of postoperative complications and long-term mortality. Further attention should be given to routine preoperative assessment of sarcopaenia to enhance patient outcomes in managing cardiac disease among the elderly.

Data availability

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

Abbreviations

CT:

Computed tomography

CPB:

Cardiopulmonary bypass

ESMCSA :

Cross-sectional areas of the erector spinae muscles

BSA:

Body surface area

CSA:

Cross-sectional area

L3:

Third lumbar

CONUT:

Controlling nutritional status

CVA:

Cerebrovascular accident

AKI:

Acute kidney injury

ECMO:

Extracorporeal membrane oxygenation

IQR:

Interquartile ranges

eGFR:

Estimated glomerular filtration rate

References

  1. Global regional. National incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990–2016: a systematic analysis for the global burden of disease study 2016. Lancet. 2017;390(10100):1211–59.

    Article  Google Scholar 

  2. Etzioni DA, Liu JH, O’Connell JB, Maggard MA, Ko CY. Elderly patients in surgical workloads: a population-based analysis. Am Surg. 2003;69(11):961–5.

    Article  PubMed  Google Scholar 

  3. Delmonico MJ, Harris TB, Visser M, Park SW, Conroy MB, Velasquez-Mieyer P, et al. Longitudinal study of muscle strength, quality, and adipose tissue infiltration. Am J Clin Nutr. 2009;90(6):1579–85.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Bose C, Alves I, Singh P, Palade PT, Carvalho E, Børsheim E, et al. Sulforaphane prevents age-associated cardiac and muscular dysfunction through Nrf2 signaling. Aging Cell. 2020;19(11):e13261.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Ansaripour A, Arjomandi Rad A, Koulouroudias M, Angouras D, Athanasiou T, Kourliouros A. Sarcopenia adversely affects outcomes following cardiac surgery: A systematic review and Meta-Analysis. J Clin Med. 2023;12(17).

  6. Teng CH, Chen SY, Wei YC, Hsu RB, Chi NH, Wang SS, et al. Effects of sarcopenia on functional improvement over the first year after cardiac surgery: a cohort study. Eur J Cardiovasc Nurs. 2019;18(4):309–17.

    Article  PubMed  Google Scholar 

  7. Hoogma DF, Croonen R, Al Tmimi L, Tournoy J, Verbrugghe P, Fieuws S, et al. Association between improved compliance with enhanced recovery after cardiac surgery guidelines and postoperative outcomes: A retrospective study. J Thorac Cardiovasc Surg. 2024;167(4):1363–e712.

    Article  PubMed  Google Scholar 

  8. Ngaage DL, Cowen ME, Cale AR. Cardiopulmonary bypass and left ventricular systolic dysfunction impacts operative mortality differently in elderly and young patients. Eur J Cardiothorac Surg. 2009;35(2):235–40.

    Article  PubMed  Google Scholar 

  9. Hughes S, Leary A, Zweizig S, Cain J. Surgery in elderly people: preoperative, operative and postoperative care to assist healing. Best Pract Res Clin Obstet Gynaecol. 2013;27(5):753–65.

    Article  PubMed  Google Scholar 

  10. Pisano C, Polisano D, Balistreri CR, Altieri C, Nardi P, Bertoldo F et al. Role of Cachexia and fragility in the patient candidate for cardiac surgery. Nutrients. 2021;13(2).

  11. Surkan MJ, Gibson W. Interventions to mobilize elderly patients and reduce length of hospital stay. Can J Cardiol. 2018;34(7):881–8.

    Article  PubMed  Google Scholar 

  12. Yamamoto K, Nagatsuma Y, Fukuda Y, Hirao M, Nishikawa K, Miyamoto A, et al. Effectiveness of a preoperative exercise and nutritional support program for elderly sarcopenic patients with gastric cancer. Gastric Cancer. 2017;20(5):913–8.

    Article  PubMed  Google Scholar 

  13. Cruz-Jentoft AJ, Bahat G, Bauer J, Boirie Y, Bruyère O, Cederholm T, et al. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing. 2019;48(4):601.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Ikeno Y, Koide Y, Abe N, Matsueda T, Izawa N, Yamazato T, et al. Impact of sarcopenia on the outcomes of elective total arch replacement in the elderly†. Eur J Cardiothorac Surg. 2017;51(6):1135–41.

    Article  PubMed  Google Scholar 

  15. Lee SA, Jang IY, Park SY, Kim KW, Park DW, Kim HJ, et al. Benefit of sarcopenia screening in older patients undergoing surgical aortic valve replacement. Ann Thorac Surg. 2022;113(6):2018–26.

    Article  PubMed  Google Scholar 

  16. Kiriya Y, Toshiaki N, Shibasaki I, Ogata K, Ogawa H, Takei Y, et al. Sarcopenia assessed by the quantity and quality of skeletal muscle is a prognostic factor for patients undergoing cardiac surgery. Surg Today. 2020;50(8):895–904.

    Article  PubMed  Google Scholar 

  17. Okamura H, Kimura N, Tanno K, Mieno M, Matsumoto H, Yamaguchi A, et al. The impact of preoperative sarcopenia, defined based on Psoas muscle area, on long-term outcomes of heart valve surgery. J Thorac Cardiovasc Surg. 2019;157(3):1071–e93.

    Article  PubMed  Google Scholar 

  18. Jang HY, Shin WJ, Jeong D, Baek J, Song IK. Association between preoperative sarcopenia and early postoperative outcomes in pediatric patients undergoing total correction of tetralogy of fallot: A retrospective cohort study. J Cardiothorac Vasc Anesth. 2023;37(10):2020–6.

    Article  PubMed  Google Scholar 

  19. Oh J, Song IK, Nam JS, Lee SW, Lee EH, Choi IC. Sarcopenia as a prognostic factor for outcomes after isolated tricuspid valve surgery. J Cardiol. 2020;76(6):585–92.

    Article  PubMed  Google Scholar 

  20. Ignacio de Ulíbarri J, González-Madroño A, de Villar NG, González P, González B, Mancha A, et al. CONUT: a tool for controlling nutritional status. First validation in a hospital population. Nutr Hosp. 2005;20(1):38–45.

    PubMed  Google Scholar 

  21. Cruz-Jentoft AJ, Baeyens JP, Bauer JM, Boirie Y, Cederholm T, Landi F, et al. Sarcopenia: European consensus on definition and diagnosis: report of the European working group on sarcopenia in older people. Age Ageing. 2010;39(4):412–23.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Minegishi Y, Inoue S, Sato K, Abe K, Murano H, Furuyama K, et al. Smaller erector spinae muscle size is associated with inability to recover activities of daily living after pneumonia treatment. Respir Investig. 2019;57(2):191–7.

    Article  PubMed  Google Scholar 

  23. Miller JA, Harris K, Roche C, Dhillon S, Battoo A, Demmy T, et al. Sarcopenia is a predictor of outcomes after lobectomy. J Thorac Dis. 2018;10(1):432–40.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Roehrich L, Suendermann SH, Just IA, Kopp Fernandes L, Schnettler J, Kelle S, et al. Impact of muscle mass as a prognostic factor for failed waiting time prior to heart transplantation. Front Cardiovasc Med. 2021;8:731293.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Oshima Y, Sato S, Chen-Yoshikawa TF, Yoshioka Y, Shimamura N, Hamada R et al. Quantity and quality of antigravity muscles in patients undergoing living-donor Lobar lung transplantation: 1-year longitudinal analysis using chest computed tomography images. ERJ Open Res. 2020;6(2).

  26. Peduzzi P, Concato J, Feinstein AR, Holford TR. Importance of events per independent variable in proportional hazards regression analysis. II. Accuracy and precision of regression estimates. J Clin Epidemiol. 1995;48(12):1503–10.

    Article  CAS  PubMed  Google Scholar 

  27. Cruz-Jentoft AJ, Sayer AA, Sarcopenia. Lancet. 2019;393(10191):2636–46.

    Article  PubMed  Google Scholar 

  28. Mori H, Tokuda Y. Differences and overlap between sarcopenia and physical frailty in older community-dwelling Japanese. Asia Pac J Clin Nutr. 2019;28(1):157–65.

    CAS  PubMed  Google Scholar 

  29. Bielecka-Dabrowa A, Ebner N, Dos Santos MR, Ishida J, Hasenfuss G, von Haehling S. Cachexia, muscle wasting, and frailty in cardiovascular disease. Eur J Heart Fail. 2020;22(12):2314–26.

    Article  PubMed  Google Scholar 

  30. Knoedler S, Schliermann R, Knoedler L, Wu M, Hansen FJ, Matar DY, et al. Impact of sarcopenia on outcomes in surgical patients: a systematic review and meta-analysis. Int J Surg. 2023;109(12):4238–62.

    PubMed  PubMed Central  Google Scholar 

  31. Machii Y, Kitashima F, Hayashi Y, Harada A, Kamata K, Eguchi N, et al. Preoperative sarcopenia assessment using pectoralis muscle mass indicated poor Mid-term cardiac surgery prognosis. Heart Surg Forum. 2023;26(6):E880–8.

    Article  PubMed  Google Scholar 

  32. Ueda D, Tsutani Y, Kamigaichi A, Kawamoto N, Tsubokawa N, Ito M et al. Impact of the amount of preoperative erector spinae muscle in stage I non-small-cell lung cancer. Eur J Cardiothorac Surg. 2022;63(1).

  33. Giraudo C, Librizzi G, Fichera G, Motta R, Balestro E, Calabrese F, et al. Reduced muscle mass as predictor of intensive care unit hospitalization in COVID-19 patients. PLoS ONE. 2021;16(6):e0253433.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Oshima Y, Sato S, Chen-Yoshikawa TF, Nakajima D, Nankaku M, Date H, et al. Erector spinae muscle radiographic density is associated with survival after lung transplantation. J Thorac Cardiovasc Surg. 2022;164(1):300–e113.

    Article  PubMed  Google Scholar 

  35. Liu Z, Shen Z, Zhang P, Zhu G, Wang S, Liu Q, et al. Prognostic effect of thoracic sarcopaenia on Short- and Long-Term clinical outcomes in patients who underwent cardiac valve surgery. Heart Lung Circ. 2022;31(10):1408–18.

    Article  CAS  PubMed  Google Scholar 

  36. Sato M, Tamura Y, Murao Y, Yorikawa F, Katsumata Y, Watanabe S, et al. The cross-sectional area of erector spinae muscle and the liver-to-spleen ratio are associated with frailty in older patients with diabetes: a cross-sectional study. BMC Geriatr. 2023;23(1):765.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Johnston A, Mesana TG, Lee DS, Eddeen AB, Sun LY. Sex differences in Long-Term survival after major cardiac surgery: A Population-Based cohort study. J Am Heart Assoc. 2019;8(17):e013260.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Dismorr M, Granbom-Koski M, Ellfors E, Rück A, Settergren M, Sartipy U, et al. Sex differences and long-term clinical outcomes after transcatheter aortic valve replacement: A SWEDEHEART study. Am Heart J. 2024;277:27–38.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

We thank all the participants for their contribution in the study.

Funding

Not applicable.

Author information

Authors and Affiliations

  1. Department of Clinical Nutrition, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, China

    Xiaoqian Wang, Zhen Wang & Xiaotian Chen

  2. Department of Cardiac Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, China

    Yongqing Cheng

Authors
  1. Xiaoqian Wang
    View author publications

    You can also search for this author inPubMed Google Scholar

  2. Zhen Wang
    View author publications

    You can also search for this author inPubMed Google Scholar

  3. Yongqing Cheng
    View author publications

    You can also search for this author inPubMed Google Scholar

  4. Xiaotian Chen
    View author publications

    You can also search for this author inPubMed Google Scholar

Contributions

CXT and WXQ designed the work. WXQ drafted the manuscript. WXQ, WZ and CYQ participated in collection and analysis of data. WZ contributed to re-analysis the data and checked the tables and figures. CXT and CYQ critically revised the manuscript. All authors read and approved the final manuscript.

Corresponding authors

Correspondence to Zhen Wang, Yongqing Cheng or Xiaotian Chen.

Ethics declarations

Ethics approval and consent to participate

The study protocol was approved by the Hospital Clinical Research Ethics Committee of Nanjing Drum Tower Hospital (no.2022-216-01), with informed consent requirements waived. All procedures performed in studies involving human participants adhered to the principles of the Declaration of Helsinki.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wang, X., Wang, Z., Cheng, Y. et al. Effects of sarcopenia on postoperative recovery in elderly patients after cardiac surgery with cardiopulmonary bypass. BMC Geriatr 25, 295 (2025). https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s12877-025-05966-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s12877-025-05966-x

Keywords

BMC Geriatrics

ISSN: 1471-2318

Contact us