Measuring Ultrasound Guided Skeletal Muscle Mass of Lower Extremity as a Predictor of Post-operative Length of Stay in Exploratory Gynae-Oncology surgeries

Gynae-oncological patients comprise a significant proportion of all new cancers and death related to cancer. Abrupt increase in the incidence of these cancer is observed specifically between women of 50-60 years of age. Therefore, it is important to evaluate the factors which influence postoperative outcomes in such patients. Sarcopenia, defined as a progressive and generalized loss of skeletal muscle mass, quality, and strength is considered a reliable indicator of frailty, a poor prognostic factor in cancer.

Usually, various frailty scores and measurement of psoas muscle mass with the abdominal pelvic CT scan are used as markers of sarcopenia. But these scores are time consuming, can’t be done in patients unable to walk and altered mental status. Routine use of CT scan exposes the patient to radiation and may not be necessary.

We wanted to evaluate if bedside ultrasound guided skeletal muscle measurement, as a measure of sarcopenia, can be used to predict adverse post operative outcomes in open gynae-oncology surgery in moderate to high risk patients (Charlson Comorbidity Index score of 3 or more) of more than 50 years of age.

This will be a prospective observational cohort study. Total 320 patients will be recruited considering 1:1 ratio of sarcopenia vs non sarcopenia, in moderate-to-high risk patients above the age of 50 years undergoing open gynae-oncology surgery.

We will be collecting all relevant data other than skeletal muscle mass measurement (psoas major, rectus femoris, vastus intermedius and tibialis anterior) that can contribute to adverse post operative outcomes. In the preoperative period Charlson’s comorbidity index, Serum albumin, creatinine and blood haemoglobin value, preoperative Functional status by 6-minute walk test, existing frailty by using Fried phenotype score and if patient has received neoadjuvant chemotherapy will be noted. Intraoperatively duration of surgery, Surgical complexity score, blood loss will be collected. In the post-operative period, length of hospital stay, Clavien Dindo score, post-operative morbidity score, 30 and 90 days readmission and 30- and 90-day mortality after discharge will be noted.

The outcome measured will be:

Primary outcome: Prolonged length of hospital stay.

Secondary outcomes:

• Incidence of severe morbidity as classified by the Clavien Dindo Score.

• Type of morbidity as defined by the Post Operative Morbidity Survey

• 30-day and 90-day readmission.

• 30-day and 90-day mortality.

All the data collected will be analyzed by appropriate statistical methods and the study will be concluded