Sarcopenia as a Preoperative Risk Stratification Tool Among Older Adults with Inflammatory Bowel Disease
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Project Summary/Abstract: Inflammatory bowel disease (IBD), comprised of Crohn’s disease and ulcerative colitis, is a chronic disorder caused by dysregulation of the immune system. Initially thought to predominantly be a disease of the young, improved treatments, decreasing mortality, and steady incidence have shifted the landscape of IBD. Over the next decade, older adults (≥60 years of age) with IBD are expected to comprise more than one-third of the entire IBD patient population. Despite this, older adults with IBD are often omitted from research studies, limiting the data available to make optimal clinical decisions. One area this is particularly important in, is preoperative planning. Older adults with new onset IBD have over a 20% 5-year incidence of surgery, four times higher odds of postoperative mortality as compared to younger patients, and a one-third chance of experiencing a major complication as a result of surgery. Due to the lack of adequate preoperative risk stratification tools, clinicians often prescribe prolonged periods of ineffective and potentially harmful therapies in hopes of avoiding surgery, further increasing this surgical risk. Thus, adequate preoperative risk stratification tools are imperative to improving the care of older adults with IBD. Sarcopenia is one such risk stratification tool that has been associated with postoperative outcomes in patients undergoing abdominal surgery. Currently, however, there are no studies assessing this in older patients with IBD, and no standardized way to assess muscle mass and density based on routine preoperative imaging in IBD. Therefore, the goal of this proposal is to determine the cross-sectional measure of muscle that is most predictive of postoperative complications among older adults with IBD, and to build a preoperative risk stratification tool that combines cross-sectional imaging assessments of muscle with known IBD and surgical risk factors. A retrospective review of all patients with IBD ≥ 60 years of age who have undergone IBD-related surgery will be performed, measuring preoperative Total Psoas Index, Skeletal Muscle Index, and Hounsfield Unit Average Calculations on imaging. Our primary outcome will be a 30-day composite of postoperative mortality and major complications. A multivariable model combining the optimal cross-sectional measure of muscle mass along with known surgical risk factors will then be used to predict the risk of postoperative complications among older adults with IBD. This will be the first study to assess sarcopenia in older adults with IBD, and will serve as the foundation for future risk stratification models in this subpopulation. As part of my career development, this award will generate preliminary data that can be used to inform prospective validation studies, incorporating additional measures of sarcopenia such as grip strength. Additionally, under the guidance of my mentorship team, I will simultaneously develop new skills in aging research that I can carry forward in subsequent studies at the intersection of gerontology and IBD.
