Preoperative Sarcopenia and Postoperative Activities of Daily Living Decline in Patients Undergoing Elective Cardiovascular Surgery

Background: Postoperative declines in activities of daily living (ADL) are concerning in older adults undergoing cardiovascular surgeries. Sarcopenia represents a determinant of such adverse outcomes. We examined whether preoperative sarcopenia and its components predicted postoperative ADL decline in older patients who underwent elective cardiovascular surgeries. Methods and Results: This retrospective cohort study included 589 patients aged ≥65 years who underwent elective coronary artery bypass grafting, heart valve surgery, or thoracic aortic surgery. Sarcopenia was defined according to the Asian Working Group for Sarcopenia 2019 criteria. ADLs were assessed using the Barthel Index, with in-hospital ADL decline being defined as a ≥10-point reduction. Thirty-three (5.6%) patients had sarcopenia preoperatively. ADL decline was significantly higher in the patients with sarcopenia compared with those without (15.2% vs. 5.0%; P=0.014). Multivariable logistic regression analyses demonstrated that sarcopenia was independently associated with ADL decline (odds ratio 3.094; 95% confidence interval 1.067-8.968; P=0.038). Each sarcopenia component - low muscle mass, low muscle strength, and slow gait speed - was also independently associated with ADL decline (all P<0.050). Age-adjusted receiver operating characteristic analyses showed that sarcopenia demonstrated moderate discrimination for predicting postoperative ADL decline, with an area under the curve of 0.707. Conclusions: Preoperative sarcopenia and its individual components independently predicted in-hospital ADL decline following cardiovascular surgery. Preoperative assessments may help identify high-risk patients.