The effect of sarcopenia on postoperative complications in autologous breast reconstruction: A systematic review and meta-analysis.

Abstract

Sarcopenia refers to a loss of muscle mass combined with an associated loss of muscle function and has been demonstrated to predict post operative complications across a range of surgical procedures. The effect of sarcopenia on patient outcomes following autologous breast reconstruction (ABR) remains unknown. This systematic review and meta-analysis aims to assess the impact of sarcopenia on complications following ABR. A systematic review of electronic databases was performed in conjunction with PRISMA guidelines. Studies reporting on postoperative complications in sarcopenic versus non-sarcopenic patients undergoing autologous breast reconstruction were included. Sarcopenia was identified in all included studies by objectively measuring psoas muscle index (PMI) or skeletal muscle index (SMI) on computed tomography (CT) scan. Six studies were included in this meta-analysis, which reported outcomes of 1315 patients undergoing ABR following mastectomy (407:908, Sarcopenic: Non-Sarcopenic). Sarcopenic patients had an increased risk of haematoma formation (OR= 1.84, 95% CI=1.06-3.18, p=0.03), but this was not associated with an increased risk of return to theatre due to haematoma (OR=1.11, 95% CI=0.36-3.38, p=0.86). There was no significant difference in risk of total flap loss, recipient site infection, recipient site seroma formation, donor site complications, risk of re-operation or wound dehiscence between sarcopenic and non-sarcopenic patients following ABR. This study reports a higher haematoma risk in sarcopenic patients undergoing autologous breast reconstruction. Prospective studies reporting on BMI, PMI/SMI, radiographic muscle attenuation, and patient-reported return to function are required to comprehensively evaluate the potential impact of sarcopenia on post-mastectomy autologous breast reconstruction.