Effect of sarcopenia in patients undergoing sacrum tumor resection with intra-aortic balloon occlusion: a retrospective cohort study

Background: Sacrum tumor resection is with a high rate of complications due to complex anatomy, massive bleeding and tumor malignancy. Intra-aortic balloon occlusion (IABO) can reduce intraoperative bleeding and shorten the operation time. It is a safe and effective way to control intraoperative bleeding and has been clinically verified and widely used in sacral tumor resection surgeries. Most recently sarcopenia has been found to be associated with elevated surgical complications. However the effect of sarcopenia on complications after sacrectomy with temporary IABO has not been investigated. Methods: This is a retrospective cohort study. We reviewed the anesthesia records and medical data of all patients (aged between 14 and 76) who underwent sacral tumor surgery and applied IABO technology from 2018 to 2021. Patients were divided into the sarcopenia group and the control group based on the skeletal muscle mass index at the L3 level. According to the Clavien-Dindo classification, the primary outcome was Clavien-Dindo classification grades ≥ 2. Mediation analysis was used to explore the relationship between hemodynamic instability, sarcopenia, and postoperative complications. Results: Finally 221 patients were included in this study, with 96 patients in Sarcopenia Group and 125 patients in Control Group. The incidence of Clavien-Dindo classification grades ≥ 2(P = 0.007), Postoperative surgical debridement (9/96 (9.4%) vs. 3/125 (2.4%), P = 0.023), and blood transfusion postoperatively (27/96(28.1%) vs. 21/125 (16.8%), P = 0.043) in the sarcopenia group was higher than that in the control group. Multivariate logistic regression showed that sarcopenia and hemodynamic instability are independent risk factors for Clavien-Dindo classification grades ≥ 2(P=0.037). Conclusions: Sarcopenia is associated with a higher incidence and severity of surgical complications in patients undergoing sacrectomy and receiving IABO. Intraoperative hemodynamic instability plays a partially mediating role in this. Clinical trial number and registry URL: Not applicable.