201. PREOPERATIVE HANDGRIP STRENGTH IS ASSOCIATED WITH POSTOPERATIVE PULMONARY COMPLICATIONS AFTER MAJOR ABDOMINAL SURGERY: A PROSPECTIVE MULTICENTRE INTERNATIONAL COHORT STUDY
Renishka Sellayah, Ianthe Boden- Gastroenterology
- General Medicine
Abstract
Background
Low muscle strength is a primary indicator of sarcopenia, defined by the European Working Group on Sarcopenia (EWGSOP2) and is related to postoperative complications after major surgery. Handgrip strength is easily measured preoperatively and is an alternative to skeletal muscle index assessments, which are time consuming and require specialised equipment. The current studies pertaining to handgrip and postoperative outcomes are largely retrospective, single-centre studies in populations dissimilar to Australian and New Zealand surgical patients.
Methods
Patient-level data from the Lung Infection Prevention Post Surgery—Major Abdominal—with Pre-Operative Physiotherapy study (ANZCTR 12613000664741), a randomised controlled trial conducted across three Australian and New Zealand tertiary hospitals (2013–2015) was utilised. Eligible patients were those listed for elective upper abdominal surgery. Maximum dominant handgrip was measured via standardised methods. Percentage of predicted handgrip was calculated using recognised normative values; <85% predicted was set as signifying low handgrip strength. The association between <85% of predicted handgrip and postoperative outcomes was analysed using multivariate regression modelling adjusted for covariate effects of age, gender, ASA, smoking status, and type of surgery.
Results
Of 432 participants (50% colorectal, 25% UGI/HPB) hand grip data was available for 379 (88%). Patients with low preoperative handgrip had a four-fold increased risk of developing a postoperative pulmonary complication (RR 3.95; 95% CI 1.09 to 14.2; p = 0.037) independent of other confounding variables. Handgrip had the strongest effect on postoperative pulmonary complications compared to age, gender, upper gastrointestinal, hepatobiliary surgery, ASA, and current smoking. There were consistent signals of a relationship between preoperative weak hand grip and MET calls, extraordinary physician ward consults, prolonged length of hospital stay (>14 days), sub-acute stays, and longer time to independent mobilisation.
Conclusion
This is the first study of handgrip in Australian and New Zealand surgical patients. It prospectively validates previous findings that weak handgrip is related to worse postoperative outcomes, particularly respiratory. Intriguingly, handgrip had a stronger effect on pulmonary complications than upper GI or hepatobiliary surgery. Finally, given its ease of measurement, handgrip can be assessed at first clinical contact, increasing the time available for pre-habilitation.