Kaiser Permanente study finds CT scans as part of surgical planning can also be used to assess frailty and identify high-risk patients

Kaiser Permanente says the computed tomography (CT) scan required before surgery contains information about a patient’s frailty, which can be used to identify patients at highest risk for surgical complications. New research shows.

The study, published in JAMA Surgery, suggests that muscle quantity and quality may be useful measures for doctors when discussing the risks and benefits of surgery with patients.

“Although it is widely understood that frailty impacts patient outcomes, there currently is no objective, standard measure of frailty that physicians use for all patients,” said lead author Kaiser. – said Dr. Elizabeth Cespedes Feliciano, a researcher at Permanente’s Northern California division. the study. “Our research shows that the images taken before surgery are rich in information and that we use AI algorithms to evaluate that information, which tells us more about a patient’s frailty than current electronic medical records. This shows that it is possible to create an image of

The study included 48,444 Kaiser Permanente Northern California members ages 18 and older who were hospitalized for abdominal surgery from 2010 to 2020. All patients had CT scans of their abdomen or pelvis up to three months before surgery, and fat and muscle measurements were recorded. The lumbar vertebrae were also included.

The researchers summarized the rich biological information contained in the algorithmic anatomical assessment into three scores: body size, muscle quantity and quality, and fat distribution. Of these, muscle quantity and quality provided the best assessment of patients’ frailty, an age-related physiological decline that affects resilience to stressors such as surgery.

The study found that higher muscle quantity and quality scores were inversely associated with hospital frailty risk scores. That is, the higher the muscle score, the lower the frailty score. A high muscle score was also associated with a 39% lower risk of readmission or death within 30 days and a 41% lower risk of developing complications within 30 days after surgery. These associations remained even after the researchers took into account gender, age, other medical conditions, body mass index, type and urgency of surgery, and frailty score.

“We thought muscle score was the only measure that strongly correlated with patient frailty, and that’s what we found,” said lead author and data analyst in the research department. said Ijamaka Anine Fumagalli MPH. “However, we also found that muscle score was associated with surgical outcome, independent of frailty score and other factors. This suggests that muscle quantity and quality, which can only be assessed with CT, This suggests that it can be added to existing methods of identifying

Assessment of frailty

In medicine, frailty refers to the decline in physiological reserve associated with aging and illness. “Patients with sarcopenia (a condition found in older adults) have decreased muscle mass and muscle quality, which is associated with frailty, and both frailty and sarcopenia increase the risk of postoperative complications and death. ” said the study co-authors. Peter Peng, MD, surgical oncologist at Permanente Medical Group. “Identification is important because there are interventions that can improve frailty, increase skeletal muscle mass, and lead to better outcomes after surgery.”

The findings suggest that the CT scan images that doctors use to plan surgeries can also help doctors better identify frail patients who may benefit from these interventions. Masu. “We know that physicians have an idea of ​​which patients are the most frail based on BMI and age,” Fumagalli said. “However, our study suggests that body composition is more important than body size and may provide additional information in addition to age.”

Guidelines currently recommend that all elderly patients undergo a preoperative frailty assessment to assess the risk of complications. Researchers have tried to develop ways to automatically collect information from patients’ electronic medical records to assess frailty, but finding tools accurate enough for widespread use has been difficult.

“We are moving further into the AI ​​era, and imaging AI is one of the key research areas,” said Cespedes Feliciano. “These tools can provide large amounts of data, but it also means we need to develop methods to help make sense of that data. Our research tells stories that were previously invisible. 3 This shows that it is possible to extract two measurement results.

Mr. Peng further added: “One day, automated CT skeletal muscle assessment of each whole-body CT scan will be possible, indicating the degree of sarcopenia and allowing clinicians to help patients make informed decisions about their care. It might turn out like this.”

This research was supported by the National Institute on Aging of the National Institutes of Health.

Co-authors include Sidney T. Lee, MD, Patricia Kipnis, PhD, Vincent X. Liu, MD, MS, and Bette Kahn, PhD, of the Research Department. His Vincent Chow BSc at Simon Fraser University, Dr Mirza Faisal Beg; and Dr. Caltech Potpourri of Memorial University of Newfoundland.

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About Kaiser Permanente Research Department

Kaiser Permanente’s Research Division conducts, publishes, and disseminates epidemiology and health services research to improve the health and health care of Kaiser Permanente members and society as a whole. We aim to understand the determinants of disease and health and improve the quality and cost-effectiveness of healthcare. Currently, his more than 600 staff at DOR are working on more than 450 epidemiology and health services research projects. For more information, visit divisionofresearch.kaiserpermanente.org or follow @KPDOR.