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Introduction: Sarcopenic liver transplant recipients have higher rates of mortality, but mechanisms underlying these rates remain unclear. Failure to rescue (FTR) has been shown to be a primary driver of mortality following major general and vascular surgery. We hypothesized that FTR is common in sarcopenic liver transplant recipients. Methods: We retrospectively reviewed 348 liver transplant recipients with perioperative CT scans. Analytic morphomic techniques were used to assess trunk muscle size via total psoas area (TPA). One-yr major complication and FTR rates were calculated across TPA tertiles. Results: The one-yr complication rate was 77% and the FTR rate was 19%. Multivariate regression showed TPA as a significant predictor of FTR (OR = 0.27 per 1000 mm² increase in TPA, p < 0.001). Compared to patients in the largest muscle tertile, patients in the smallest tertile had 1.4-fold higher adjusted complication rates (91% vs. 66%) and 2.8-fold higher adjusted FTR rates (22% vs. 8%). Discussion: These results suggest that mortality in sarcopenic liver transplant recipients may be strongly related to FTR. Efforts aimed at early recognition and management of complications may decrease postoperative mortality. Additionally, this work highlights the need for expanded multicenter collaborations aimed at collection and analysis of postoperative complications in liver transplant recipients. [ABSTRACT FROM AUTHOR]

Introduction Better measures of liver transplant risk stratification are needed. Our previous work noted a strong relationship between psoas muscle area and survival following liver transplantation. The dorsal muscle group is easier to measure, but it is unclear if they are also correlated with surgical outcomes. Methods Our study population included liver transplant recipients with a preoperative CT scan. Cross-sectional areas of the dorsal muscle group at the T12 vertebral level were measured. The primary outcomes for this study were one- and five-yr mortality and one-yr complications. The relationship between dorsal muscle group area and post-transplantation outcome was assessed using univariate and multivariate techniques. Results Dorsal muscle group area measurements were strongly associated with psoas area ( r = 0.72; p < 0.001). Postoperative outcome was observed from 325 patients. Multivariate logistic regression revealed dorsal muscle group area to be a significant predictor of one-yr mortality (odds ratio [ OR] = 0.53, p = 0.001), five-yr mortality ( OR = 0.53, p < 0.001), and one-yr complications ( OR = 0.67, p = 0.007). Conclusion Larger dorsal muscle group muscle size is associated with improved post-transplantation outcomes. The muscle is easier to measure and may represent a clinically relevant postoperative risk factor. [ABSTRACT FROM AUTHOR]

Abstract: Background: The practice of ambulatory surgery has expanded greatly as a result of advances in surgical technology and rising financial pressures. We sought to characterize the utilization of ambulatory surgical practices for common general surgical procedures in Michigan. Materials and methods: We identified 33,655 patients within the Michigan Surgery Quality Collaborative clinical registry undergoing general surgical procedures performed on an ambulatory basis between 25% and 75% of the time. Our primary outcome was the incidence of ambulatory surgery. Using multilevel mixed-effects logistic regression models, we adjusted ambulatory surgery utilization rates for patient comorbidities, procedure composition, and hospital characteristics. We then assessed the incidence of postoperative complications across hospitals grouped by their ambulatory surgery utilization rates. Results: Adjusted utilization rates of ambulatory surgery varied widely across 34 hospitals from 29%–75% (mean = 54%). Risk-adjusted complication rates for ambulatory cases were similar between hospitals performing the least (2.2%) and the most ambulatory surgery (2.3%, P = 0.365). Patient factors and hospital characteristics accounted for 23.3% of the between-hospital variability in ambulatory surgery utilization, whereas most variation was explained by effects at the surgeon level. Conclusions: Despite wide variation in ambulatory surgery utilization for general surgical procedures, we were unable to explain observed differences by patient comorbidities, case mix, or hospital characteristics. These data suggest that understanding factors associated with ambulatory surgery utilization may represent a novel avenue for quality improvement within our statewide surgical collaborative. [Copyright &y& Elsevier]