Perioperative management of sarcopenia in patients undergoing major surgeries in Singapore: a modified delphi consensus

Frederick H Koh; Lincoln My Chew; Nicky Wong; Alfred Wc Kow; Dominic Yap; Sherryl Ng; Jingyu Ng; Ming-Yuan Tan; Daniel Jk Lee; Angie Ps Au-Yong; Clement Ck Yan; Priscilla Darmawirya; Balachandran Jayachandran; Andrea Maier; Hazel El Yeong; Samuel Th Chew; Fung-Joon Foo; Kwang-Yeong How; Doris Hl Ng

doi:10.1097/JS9.0000000000001515

Perioperative management of sarcopenia in patients undergoing major surgeries in Singapore: a modified delphi consensus

Int J Surg. 2024 May 3. doi: 10.1097/JS9.0000000000001515. Online ahead of print.

Authors

Frederick H Koh¹, Lincoln My Chew², Nicky Wong², Alfred Wc Kow³, Dominic Yap², Sherryl Ng², Jingyu Ng³, Ming-Yuan Tan⁴, Daniel Jk Lee⁴, Angie Ps Au-Yong⁵, Clement Ck Yan¹, Priscilla Darmawirya⁶, Balachandran Jayachandran⁷, Andrea Maier⁸, Hazel El Yeong⁴, Samuel Th Chew⁹, Fung-Joon Foo¹, Kwang-Yeong How⁶, Doris Hl Ng⁶

Affiliations

¹ Sengkang General Hospital, SingHealth, Singapore.
² Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
³ National University Hospital, National University Health System, Singapore.
⁴ Khoo Teck Puat Hospital, National Healthcare Group, Singapore.
⁵ Singapore General Hospital, SingHealth, Singapore.
⁶ Tan Tock Seng Hospital, National Healthcare Group, Singapore.
⁷ Woodlands General Hospital, Woodlands Health, Singapore.
⁸ Alexandra Hospital, National University Health System, Singapore.
⁹ Changi General Hospital, Singhealth, Singapore.

PMID: 38701514
DOI: 10.1097/JS9.0000000000001515

Abstract

Background: Ageing population is a worldwide phenomenon with correspondingly higher proportion of older patients being treated in the hospital setting. Sarcopenia, which increases with age, has serious negative implications on health, hospitalization and overall postoperative recovery. There is no mutual consensus on perioperative management of sarcopenia in surgical patients in Singapore. The purpose of this study is to create greater clarity pertaining to the recognition of sarcopenia, the application of assessment criteria of sarcopenia and perioperative management of surgical patients in Singapore.

Methods: A modified Delphi consensus consisting of a panel of experts from Singapore forming a multidisciplinary team, including surgeons, geriatricians, anesthesiologists, physiotherapists and dieticians. Eight recommendations were proposed by the steering committee. Literature search from MEDLINE, Embase and Scopus for articles up till June 2023 were performed to support recommendation statements. The expert panel voted on agreement to recommendation statements and graded the level of evidence supporting each statement through surveys to achieve consensus, set at 85% a priori.

Results: The panelists underwent two rounds of anonymized, independent voting before reaching consensus for all eight statements. After the first round, seven statements reached consensus, including the corresponding grading for level of evidence. The statement which did not achieve consensus was revised with supporting literature and after the second round of survey, all eight statements and level of evidence reached consensus, completing the Delphi process. These eight statements covered themes to (1) encourage the identification of sarcopenia, (2) guide pre-operative and (3) post-operative management of sarcopenia.

Conclusion: With the varying approaches in perioperative management, poor understanding of and identification of sarcopenia can result in suboptimal management of sarcopenia in surgical patients. Given the abundance of evidence linking beneficial impact on recovery and post-operative complications with prudent management of sarcopenia, it is imperative and urgent to achieve awareness and consensus.