RESUMO
OBJECTIVE: Psoas muscle area (PMA) is a validated surrogate for muscle mass that can be easily measured from a clinical CT scan. This study sought to determine whether PMA was associated with post-operative mortality after endovascular or open aortic aneurysm repair. METHODS: A retrospective review was undertaken of patients who underwent elective endovascular or open aortic aneurysm repair between 2010 and 2015 at a tertiary vascular center in Montreal, Quebec, Canada. Pre-operative CT scan images were analyzed with the CoreSlicer.com software tool to measure PMA at the axial level of the L4 vertebrae. Measurements were made by two independent observers blinded to clinical data. The primary endpoint was all-cause mortality. RESULTS: The cohort consisted of 149 patients with a mean age of 75.6 ± 8.8 years. The mean PMA was 24.0 ± 5.8 cm2 in males, and 14.3 ± 3.1 cm2 in females. There were 31 deaths over a mean follow-up of 22.4 months. After adjusting for age, sex, revised cardiac risk index, and surgical approach, Cox regression revealed a graded association between PMA and all-cause mortality with a hazard ratio of 0.86 per cm2 (95% CI 0.79-0.93). Addition of PMA to the model with the clinical covariates resulted in an improvement in C-statistic from 0.57 to 0.67, and BIC from 307 to 301 (with lower BIC values preferred). CONCLUSIONS: PMA is independently associated with all-cause mortality after elective endovascular and open aortic aneurysm repair, and may be integrated into the pre-operative risk assessment to optimize care in high-risk frail patients.
Assuntos
Aneurisma Aórtico/cirurgia , Aortografia/métodos , Implante de Prótese Vascular/mortalidade , Angiografia por Tomografia Computadorizada , Procedimentos Endovasculares/mortalidade , Fragilidade/diagnóstico por imagem , Músculos Psoas/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , Aneurisma Aórtico/diagnóstico por imagem , Aneurisma Aórtico/mortalidade , Implante de Prótese Vascular/efeitos adversos , Composição Corporal , Procedimentos Endovasculares/efeitos adversos , Feminino , Idoso Fragilizado , Fragilidade/mortalidade , Fragilidade/fisiopatologia , Nível de Saúde , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Modelos de Riscos Proporcionais , Músculos Psoas/fisiopatologia , Quebeque , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Centros de Atenção Terciária , Fatores de Tempo , Resultado do TratamentoRESUMO
This report describes a one-year experience with a new program of group therapy for Southeast Asians who were treated in a psychiatric program for Indochinese refugees. Cultural factors involving communication styles, respect for authority, and traditional social relationships greatly influence the group process. Socialization experiences which encouraged traditional activities and practical information were the most acceptable medium by all the groups. Psychological issues of losses, cultural conflicts, and persistent discussion of somatic symptoms were voiced throughout the activities. Formal group psychotherapy was periodically useful in some groups. Flexibility, meeting concrete needs, keeping a bicultural focus, and maintaining the individual therapy sessions contributed to the acceptance by the patient.
