Low skeletal muscle mass is associated with high hospital costs in patients undergoind pancreatic cancer resection

Background: Low skeletal muscle mass is associated with poor postoperative outcomes and higher health care costs in the United States. We investigated the effect of sarcopenia on hospital expenditure in a universal access Western-European healthcare system. Methods: Sarcopenia was assessed on preoperative abdominal computed tomography scans of patients undergoing pancreatic surgeries for pancreatic adenocarcinoma. The Hounsfield Unit Average Calcucation (HUAC) was used to define sarcopenia. Health care costs were obtained for all patients and the relationship of low HUAC and higher costs was explored using linear regression and cross-sectional analysis. Results: We included 317 patients (48.5% male, median age of 63 (19-87) years) undergoing Whipples procedure (60.5%), left sided pancreatic resection (25.8%) or pancreatectomy (13.7%). The median HUAC for patients with sarcopenia was 11.41 HUAC/m2 (0.11-13.63 HUAC/m2). Hospital stay was 2 days longer in patients with low HUAC as compared to others (25 days vs 23 days; P = .001), as was duration of intensive care stay (6 days vs 3 days; P = .001). The median overall hospital costs were €5,823,8 higher for patients with sarcopenia compared with patients with a normal physical constitution (€36,107; €23,007-€62,471 vs €36,107; €29,619-€47,049]; P = .001). After confounder adjustment, sarcopenia was associated with a 51.38% cost increase in Intensive care costs, resembling an increase of €3,494.28. Conclusion: Low skeletal muscle mass is independently associated with higher hospital as well as intensive care costs in patients undergoing elective pancreatic surgery. Strategies to reduce this risk factor are warranted for these patients.