Effectiveness of Perioperative Rehabilitation in Patients with Sarcopenia Undergoing Major Hepato-Biliary-Pancreatic Surgery

Background/Objectives: A postoperative recovery capacity-enhancement program, Enhanced Recovery After Surgery (ERAS), has recently been developed according to evidence regarding perioperative management, recognizing the importance of perioperative rehabilitation. We examined the effectiveness of perioperative rehabilitation in patients with sarcopenia undergoing hepato-biliary-pancreatic (HBP) surgery. Methods: We evaluated 155 patients who underwent high-level HBP surgery from August 2017 to December 2019. We recorded their preoperative nutritional index (prognostic nutritional index and controlling nutritional status (CONUT) score), skeletal muscle index (SMI), surgical operation, and postoperative course. SMI was measured by bioimpedance analysis using an InBody S10®. Results: We analyzed data for 155 patients, including 68 in the sarcopenia (S) group and 87 in the non-sarcopenia (NS) group, according to the Asian Working Group for Sarcopenia criteria. The CONUT score was significantly higher and the nutritional status was poorer in the S group than in the NS group. The number of diabetic cases was also significantly higher in the S group than in the NS group. There was no significant difference in serious postoperative complications (Clavien–Dindo grade ≥ IIIa) between the groups, including pleural effusion and ascites that was difficult to treat. There was also no significant difference in length of hospital stay between the two groups. Conclusions: Among patients undergoing HBP surgery, patients with sarcopenia are likely to have poorer nutritional status and SMI; however, perioperative rehabilitation may help to avoid serious postoperative complications and long-term hospitalization after surgery.