Sarcopenia as a Preoperative Risk Stratification Tool Among Older Adults with Inflammatory Bowel Disease - 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.
