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

Effect of sarcopenia in patients undergoing sacrum tumor resection with intra-aortic balloon occlusion: a retrospective cohort study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Effect of sarcopenia in patients undergoing sacrum tumor resection with intra-aortic balloon occlusion: a retrospective cohort study Jiaxing Zheng, Bei An, Hong Zhao, Yi Feng This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6595292/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 5 You are reading this latest preprint version Abstract 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. sacrum tumor sarcopenia intra-aortic balloon occlusion clinical outcome Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Background Sacral tumors pose a serious threat to human health, and surgical resection is the primary treatment method. Due to the complex anatomical structure of the sacral region, significant intraoperative blood loss, and the high malignancy of the tumors, the incidence of postoperative complications is high, severely affecting patient prognosis( 1 ). To reduce intraoperative bleeding, shorten the operation time and bring the possibility of complete tumor resection, the intra-arterial balloon occlusion (IABO) technique is currently commonly used to temporarily block the abdominal aorta for the operation. There are many studies on IABO in sacral resection surgery. The common view is that this technique can reduce intraoperative bleeding and shorten the operation time, and it is a safe and effective way to control intraoperative bleeding( 2 – 4 ). Nevertheless, sacral tumor patients still experience a high rate of postoperative complications and the effect of sarcopenia on the prognosis of these patients should be investigated. Sarcopenia is a syndrome characterized by the progressive and systemic loss of skeletal muscle mass and strength. It is clinically shown as low muscle mass, low muscle strength, and/or low physical performance( 5 ), which can lead to more postoperative complications. Studies have confirmed that the prevalence of sarcopenia is high among the elderly, bedridden individuals, and people who are immobilized for a long time( 6 – 9 ), as well as patients undergoing surgery for malignant tumors. Additionally, patients with sacral tumors are especially at risk. Patients with sarcopenia usually have insufficient metabolic reserves, decreased immune function, reduced activity levels, enhanced inflammatory responses, and poor nutritional status, which affects wound healing and recovery of bodily functions, thus leading to complications. IABO aims to control bleeding by blocking aortic blood flow in specific segments through interventional techniques. However, these hemodynamic fluctuations can lead to physiological effects such as organ ischemia, thromboembolism, and ischemia-reperfusion, which could negatively impact postoperative recovery( 10 , 11 ). These effects, when combined with existing sarcopenia, could work together to impair muscle regeneration and the body's inflammatory response. Previous studies have confirmed that intraoperative hemodynamic instability is associated with postoperative complications( 12 ). For patients undergoing sacral tumor resection with IABO, first, IABO is used in surgeries with a high risk of bleeding( 13 ); second, IABO is characterized by a rapid change in afterload and organ perfusion pressure, with trauma and risk coexisting during its use( 14 ); third, sarcopenia often occurs in patients with tumors of higher malignancy, making surgery challenging. So, we speculate that intraoperative hemodynamic instability might mediate how sarcopenia affects postoperative complications. In this retrospective cohort study, we collected sacrum tumor data in 3 years, aiming to investigate the effect of sarcopenia on postoperative complications in patients undergoing sacral tumor surgery with IABO, and the mediating role of hemodynamic instability. Materials and Methods We used the anesthesia database of Peking University People's Hospital to retrieve all patients who underwent sacral tumor resection with IABO under general anesthesia from January 1, 2018, to September 28, 2021 (ages 14–76). Inclusion criteria required patients to be aged ≥ 14 years. Exclusion criteria included non-general anesthesia, sacral debridement, sacral internal fixation removal, actual non-use of IABO during surgery, and absence of pelvic-abdominal computed tomography (CT) scan results. Anesthesia data, surgical data, pathological diagnoses, length of hospital stay, and postoperative complications were collected by reviewing anesthesia records and medical charts. (The original data can be found in Attachment 1) Patients were divided into Sarcopenia group or control group according to skeletal muscle index (SMI) at the L3 acquired through preoperative CT. Clinical outcomes were compared between groups. The study protocol was approved by the Ethics Committee of Peking University People’s Hospital, Beijing, China, which waived the requirement for informed consent because of the retrospective design. This article complied with the STROBE guidelines for a retrospective study. Using the method from Amrock et al., we calculate the Chart-derived frailty index (CFI) for each patient, which includes five indicators: age > 70, Body mass index (BMI) < 18.5 kg/m², hematocrit < 35%, albumin 176.8 µmol/L (2.0 mg/dL), where each indicator is worth 1 point, and the total score is just the sum of the five indicators( 15 ). Measurement of Muscle Mass and Assessment of Sarcopenia The skeletal muscle index (SMI) at the L3 plane was obtained by normalizing with the patient's height (in square meters) ((cm²/m²) ( 16 ). Based on the characteristics of the Asian population, the diagnostic cutoff values for sarcopenia were selected: male SMI ≤ 40.31 cm²/m², female SMI ≤ 30.88 cm²/m² ( 17 ). According to these cutoff values, we divided the patients into the sarcopenia and the control group. Anesthesia management and IABO application All patients underwent tracheal intubation and general anesthesia, with continuous monitoring of invasive arterial blood pressure and central venous pressure during the procedure, maintaining a systolic blood pressure > 90 mmHg to balance organ perfusion and bleeding risk. The application of IABO was based on preoperative CT confirming a tumor volume exceeding 200 cm 3 , with rich blood supply to the tumor or invasion of the S2-S3 intervertebral disc space( 18 ). All patients received temporary IABO. After anesthesia induction, a dual-lumen balloon (MAXILD; Cordis, Johnson & Johnson, Bridgewater, New Jersey) was inserted percutaneously into the patient's right femoral artery and advanced to the abdominal aorta. Once the puncture was done, an X-ray C-arm was used to find the balloon's position. Calculation of Intraoperative Hemodynamic Variability Invasive blood pressure was recorded every 10 seconds through a radial artery during the surgery in the Anesthesia Information Management System (AIMS) and data were exported for further analysis. Hemodynamic fluctuation was represented as fractional change in median MAP (FCM), which was calculated based on the absolute change in MAP between consecutive 5-minute intervals. The median MAP was calculated over 5-minute intervals throughout the procedure. The fractional change in median MAP was determined by subtracting the median MAP of the following 5 minutes from that of the preceding 5 minutes, then dividing by the median MAP of the preceding interval. Number of FCM episodes (in absolute values) exceeding a prespecified threshold of > 0.05, 0.10, 0.15, 0.20 and 0.25 were calculated. (Select the first result that demonstrates statistical significance at a significance level of 0.05 as the threshold) Clinical Outcomes The primary outcome of this study is the incidence of postoperative complications of grade 2 or higher in patients. According to the Clavien-Dindo classification, grade 1 includes postoperative fever (temperature ≥ 38 degrees( 19 )), grade 2 includes postoperative blood transfusion, pulmonary complications grade 2, grade 3 includes postoperative debridement, postoperative cerebrospinal fluid leak, pulmonary complications grade 3, grade 4 includes postoperative admission to the intensive care unit (ICU), pulmonary complications grade 4, and grade 5 is death. Clavien-Dindo classification grades ≥ 2 following sacral tumor surgery are defined as a composite outcome that includes postoperative blood transfusion, postoperative debridement, cerebrospinal fluid leakage, postoperative admission to the ICU, and pulmonary complications grade 2 and above. Statistical Analysis Statistical analysis was performed using SPSS software (version 27.0, IBM SPSS Statistics, Chicago, Illinois, USA). The normal distribution of different variables was tested using the Kolmogorov-Smirnov test. Normally distributed continuous data were expressed as mean ± standard deviation (x ± s), and intergroup comparisons were conducted using independent t-tests. Non-normally distributed continuous data were expressed as median (M) and interquartile range (IQR), with intergroup comparisons performed using the Mann-Whitney U test. Categorical data comparisons were conducted using the χ2 test or Fisher's exact probability test. A P value of < 0.05 was considered statistically significant. Multivariate logistic regression was adopted to identify risk factors for Clavien-Dindo classification grades ≥ 2. The impact of sarcopenia on Clavien-Dindo classification grades ≥ 2 is at least partially mediated by intraoperative hemodynamic instability, and three conditions must be met: 1. Sarcopenia must necessarily affect the occurrence of fractional change in mean arterial pressure(FCM) > 15%; 2. The occurrence of FCM > 15% must influence postoperative complications and be independent of the effect of sarcopenia; 3. The mediating effect must be significant. Mediation effect analysis was conducted using SPSS Bootstrap, the dependent variable is set as Clavien-Dindo classification grades ≥ 2, the independent variable as sarcopenia, and the mediating variable as FCM > 15%. The percentile bootstrap method is used to obtain a 95% confidence interval to assess the mediating effect. Results We screened a total of 355 patients, and after reviewing all their medical records, 134 patients were excluded because the IABO not used during the actual surgery (n=49), the anesthesia method was local anesthesia (n=7), the anesthesia method was monitored anesthesia (n=7), the surgical method was sacral debridement (n=4), sacral internal fixation removal (n=1), and there were no CT results (n=66). Finally, 221 patients who underwent sacrectomy were included in this study. A total of 221 patients were included in this study, with 96 patients in sarcopenia group and 125 patients in control group. (Figure 1 ) Patients in Sarcopenia group had significantly lower BMI, more patients receiving preoperative chemotherapy, and more patients were more than 60 years of old, and more patients had malignant tumor, compared with patients in control group. In terms of surgical approach, both groups primarily underwent posterior approach resection, but the sarcopenia group had a significantly higher rate of combined anterior and posterior approach resection compared to the control group. There were no differences between the two groups in terms of gender, American society of Aneshesiologists (ASA) classification, underlying diseases, duration of surgery, duration of anesthesia, IABO block time, or secondary surgeries (p > 0.05). (Table 1 [1] ) The results of the anesthesia data analysis show that the proportion of massive bleeding(>2000mL) i.e. in the sarcopenia group was significantly higher (16/96 (16.7%) vs 6/125 (4.8%), p=0.006) . The intraoperative plasma input volume, fluid input volume, urine output, and fluid overload ratio were all significantly higher than in the control group. The CFI related indicators（albumin, hematocrit, BMI, and creatinine）are lower among those with sarcopenia group(p<0.001). Regarding intraoperative hemodynamic instability, the minimum occurrence was 0 times and the maximum was 14 times, with the sarcopenia group experiencing a higher number of hemodynamic instability events (4(4) vs 3(4), p=0.008). There were no differences in hospital stay duration, prolonged hospital stay (hospital stay longer than 28 days) or wound drainage volume between the two groups (p>0.05). (Table 2) The Clavien-Dindo classification shows that the sarcopenia group has a significantly higher rate of Clavien-Dindo classification grades ≥ 2 for patients in the sarcopenia group compared to the control group(p=0.007). (Figure 2)The incidence of postoperative fever (body temperature ≥ 38°C) i.e. Clavien-Dindo grade 1 complication, in the sarcopenia group was 36.5% (35/96), vs. 29.6% (37/125) in the control group, and there was no statistical difference between groups (p=0.281). The incidence of postoperative blood transfusion i.e. Clavien-Dindo grade 2 complication, in the sarcopenia group was 28.1% (27/96), vs. 16.8% (21/125) in the control group, and there was a statistical difference between groups (p=0.043).The incidence of pulmonary complications grade 2 i.e. Clavien-Dindo grade 2 complication, in the sarcopenia group was 2.1% (2/96), vs. 0 in the control group, and there was no statistical difference between groups (p=0.105).The incidence of debridement i.e. Clavien-Dindo grade 3 complication, in the sarcopenia group was 9.4% (9/96), vs. 2.4%(3/125) in the control group, and there was a statistical difference between groups (p=0.023).The incidence of cerebrospinal fluid leak i.e. Clavien-Dindo grade 3 complication, in the sarcopenia group was 2.1% (2/96), vs. 3.2%(4/125) in the control group, and there was no statistical difference between groups (p=0.613).The incidence of pulmonary complications grade 3 i.e. Clavien-Dindo grade 3 complication, in the sarcopenia group was 9.4% (9/96), vs. 3.2%(4/125) in the control group, and there was no statistical difference between groups (p=0.053).The incidence of ICU admittance i.e. Clavien-Dindo grade 4 complication, in the sarcopenia group was 7.3% (7/96), vs. 2.4%(3/125) in the control group, and there was no statistical difference between groups (p=0.083).The incidence of pulmonary complications grade 4 i.e. Clavien-Dindo grade 4 complication, in the sarcopenia group was 1% (1/96), vs. 1.6%(2/125) in the control group, and there was no statistical difference between groups (p=0.772). (Table 3) Due to the statistical differences in complication rates between the two groups, we looked into potential factors related to Clavien-Dindo classification grades ≥ 2. In the univariate analysis, we found that sarcopenia and FCM > 15% had p-values less than 0.05, while the p-values for preoperative albumin and low preoperative albumin were near 0.05 (Table 4). The multivariate logistic regression results showed that sarcopenia (OR: 1.847; 95% CI: 1.008-3.383; p = 0.047) and FCM> 15% (OR: 1.190; 95% CI: 1.037-1.320; p = 0.001) were independent risk factors for Clavien-Dindo classification grades ≥ 2.(Figure 3) To assess the predictive ability of sarcopenia and FCM >15% for Clavien-Dindo classification grades ≥ 2, we plotted the ROC curve and calculated the area under the curve (AUC), with the AUC for sarcopenia and FCM >15% at 0.656 (95% CI: 0.574-0.737). (Figure 4) The results of the mediation effect analysis show that the direct effect ratio is 20.76%, which means that hemodynamic instability acts as a partial mediator in the occurrence of Clavien-Dindo classification grades ≥ 2 associated with sarcopenia. (Table 5 and Figure 5). Discussion In this study, we explored for the first time the impact of sarcopenia on postoperative complications in patients undergoing sacral tumor resection with IABO. The results indicate that sarcopenia increases the risk of postoperative complications and is an independent risk factor for these complications. We found that patients in the sarcopenia group had a significantly higher incidence of Clavien-Dindo classification grades ≥ 2, postoperative blood transfusions, and postoperative debridement compared to the control group. Furthermore, hemodynamic instability plays a mediating role between sarcopenia and Clavien-Dindo classification grades ≥ 2. This study found that the incidence of Clavien-Dindo classification grades ≥ 2 is significantly increased in patients with sarcopenia, indicating the important impact of sarcopenia on postoperative complications, which is consistent with previous studies showing that sarcopenia is associated with an increased risk of various postoperative complications( 20 – 22 ). In the analysis of specific postoperative complications, the incidence of debridement due to wound infection in the sarcopenia group was significantly higher than that in the control group, which is consistent with a retrospective study (n = 395) that identified reduced lumbar muscle area as an independent risk factor for complications such as wound infection after spinal surgery (adjusted OR = 2.42, 95% CI 1.17–5.01, p = 0.016). After controlling for age, coronary artery disease, and smoking status, it also confirmed the conclusion that patients with lower lumbar muscle area have an increased risk of debridement due to wound infection postoperatively.( 23 ) possibly related to mechanisms such as immune function suppression, inflammation regulation, muscle metabolism imbalance, and tissue repair disorders. Reduced muscle mass may affect protein metabolism and the secretion of anti-inflammatory factors such as IL-6 and IL-15, while also decreasing the inhibitory effect on pro-inflammatory factors( 24 , 25 ). The decline in muscle metabolic function cannot provide the necessary proteins and growth factors for wound repair, and the stress condition of surgery exacerbates the imbalance in muscle metabolism, ultimately leading to reduced postoperative infection resistance and delayed wound healing in sarcopenic patients( 26 , 27 ), which can be validated by the higher incidence of debridement in these patients. Furthermore, the increased need for blood transfusions in sarcopenic patients postoperatively may be related to sarcopenia-associated anemia( 28 ), coagulation dysfunction( 29 ), and the characteristic of increased intraoperative bleeding during sacral tumor resection. Our data show that patients in the sarcopenia group had significantly higher proportions of preoperative anemia and intraoperative massive hemorrhage (> 2000ml) than those in the control group. Moreover, the proportion of preoperative CFI ≥ 2 (manifested by low albumin levels, hematocrit, and BMI) was also higher in the sarcopenia group. This bleeding tendency may result from multiple pathophysiological mechanisms. Chronic inflammation associated with sarcopenia can exacerbate anemia by upregulating hepcidin levels through IL-6-mediated inhibition of erythropoiesis, while low albumin impairs platelet aggregation by reducing thromboxane A2 synthesis.( 30 )Frail may contribute to an increased risk of major bleeding by reducing cardiovascular stress tolerance, impairing the balance between angiogenesis and repair, delaying vessel closure due to dysregulation, and compromising liver synthesis of coagulation factors ( 31 ). Ultimately, it leads to an increase in the demand for blood transfusion among patients with sarcopenia after surgery. This study found that the related factors of sarcopenia include older age, low BMI, low L3 SMI, malignant tumors, preoperative chemotherapy, and lower levels of hemoglobin and albumin, indicating a multifactorial pathogenesis of sarcopenia in the surgical population ( 32 , 33 ).Age is a physiological factor in the occurrence of sarcopenia, and this study found that the incidence of sarcopenia is higher in the elderly population aged ≥ 60 years( 34 ). Additionally, low muscle mass, such as low BMI and low waist muscle area, reflects a decrease in body function, which can affect the intake and utilization of nutrients( 35 , 36 ), leading to the occurrence of sarcopenia. Some studies have found that chemotherapy in patients with malignant tumors increases the incidence of sarcopenia( 37 – 40 ), which is consistent with the conclusions of this study. Furthermore, this study further confirmed that the key biomarkers of sarcopenia, hemoglobin and albumin, are negatively correlated with sarcopenia ( 41 , 42 ). Patients in the Sarcopenia group had a significantly lower CFI, including low BMI, hypoproteinemia, anemia, abnormal renal function. These indicators are all related to postoperative wound infection, delayed healing and pulmonary complications. A low BMI may manifest as a decline in the body's functions, reduced intake and utilization of nutrients, resulting in a decreased ability of the body to cope with surgical stress, thereby increasing the risks of postoperative infection and delayed wound healing, and raising the risk of postoperative debridement ( 35 , 36 ). Low protein, anemia and abnormal blood creatinine levels can trigger chronic inflammatory responses and affect postoperative recovery( 43 – 45 ). In the analysis of risk factors for Clavien-Dindo classification grades ≥ 2, it was found that sarcopenia has an independent association with these complications, increasing the risk of postoperative complications by nearly twofold. This further confirms previous evidence that muscle wasting impairs the body's overall resistance to surgical stress, and insufficient muscle mass is directly related to poor postoperative outcomes. In the analysis of the relationship between sarcopenia, frailty index, and Clavien-Dindo classification grades ≥ 2, it was found that the proportion of patients with preoperative CFI ≥ 2 in the sarcopenia group was significantly higher than that in the control group, suggesting a significant synergy between sarcopenia and frailty status in perioperative patients. Clinically, muscle assessment should be regarded as a core component of frailty management( 42 ). Regarding intraoperative hemodynamic instability factors, we first conducted a mediation effect analysis, and the results were consistent with our expectations, indicating that hemodynamic instability plays a partial mediating role in the incidence of Clavien-Dindo classification grades ≥ 2 in patients with sarcopenia. Secondly, in the multifactorial analysis of Clavien-Dindo classification grades ≥ 2, FCM > 15% was identified as an independent predictive factor. ROC curve analysis of sarcopenia and FCM > 15% revealed that their combination could enhance the predictive ability for Clavien-Dindo classification grades ≥ 2. In patients undergoing sacral tumor surgery, those with sarcopenia have a significantly increased proportion of intraoperative massive bleeding(>2000ml), leading to a higher incidence of hemodynamic instability caused by massive bleeding, which affects intraoperative blood pressure and cardiac output, ultimately resulting in inadequate perfusion of vital organs and increasing the risk of postoperative complications. Therefore, implementing effective hemodynamic monitoring and management strategies is one of the key factors to ensure surgical success. Appropriate fluid resuscitation can effectively improve the hemodynamic status of patients and reduce the occurrence of intraoperative hypotension; however, excessive fluid input may lead to increased cardiac burden and a higher risk of postoperative pulmonary complications( 46 ).. Thus, developing an individualized fluid management plan and dynamically adjusting it based on the patient's specific condition is a necessary measure to achieve favorable postoperative outcomes. Although this study provides data related to postoperative complications of sacral tumors, there are also some limitations. First, the retrospective nature of the study limits the data we can collect. Additionally, it remains unknown whether sacral tumors lead to changes in skeletal muscle area at the L3 level, which requires further studies to confirm. This study may be criticized for its retrospective design and the outcomes assessed during the hospital stay. Furthermore, the study did not collect follow-up information to investigate the patients' conditions after discharge, which presents certain shortcomings. Early identification and intervention measures for sarcopenia will be key to improving postoperative prognosis in patients with sacral tumors. Future research could focus on the following aspects: first, prospective experiments are needed to verify the expression of sarcopenia in a larger clinical sample and its relationship with the prognosis of patients with sacral tumors; second, exploring the specific mechanisms of sarcopenia in the postoperative recovery of sacral tumor patients, particularly its interactions with other clinical factors; finally, developing intervention strategies targeting sarcopenia and validating their effectiveness in clinical practice. These studies will help to comprehensively understand the role of sarcopenia in sacral tumor patients and provide new strategies for improving postoperative management. Conclusions Overall, in this retrospective cohort study on postoperative complications in patients undergoing sacral tumor surgery, sarcopenia was found to be associated with a higher incidence and severity of surgical complications in patients who underwent sacrectomy and received IABO, and it is an independent risk factor for Clavien-Dindo classification grades ≥ 2. Intraoperative hemodynamic instability plays a mediating role between sarcopenia and Clavien-Dindo classification grades ≥ 2. Abbreviations Abbreviation Full Term AIMS Anesthesia information management system ASA American society of Aneshesiologists AUC Area Under Curve BMI Body mass index CFI chart-derived frailty index CRC Concentrated red bloodcells CT Computed Tomography FFP Fresh frozen plasma FCM fractional change in mean arterial pressure IABO intra-aortic balloon occlusion ICU Intensive Care Unit IQR Interquartile spacing MAP mean arterial pressure SMI skeletal muscle mass index Declarations Ethics approval and consent to participate ：The study protocol was approved by the Ethics Committee of Peking University People’s Hospital, Beijing, China, which waived the requirement for informed consent because of the retrospective design. This article complied with the STROBE guidelines for a retrospective study. Consent to Participate declaration: Not applicable. Clinical trial number: Not applicable. Consent for publication： Not applicable. Availability of data and materials: All data generated or analysed during this study are included in this published article [and its supplementary information files]. Competing interests: The authors declare that they have no competing interests. Funding: Beijing Municipal Natural Science Foundation (grant No. M22010). Authors' contributions: JXZ conceptualized the study, designed the methodology, performed data analysis, and wrote the original draft. HZ supervised the project, acquired funding, reviewed and edited the manuscript, and approved the final version for submission. BA contributed to data curation, validation, and formal analysis. YF provided clinical expertise, interpreted results, and critically revised the manuscript for intellectual content. All authors read and approved the final manuscript. Acknowledgements: Not applicable. References Huang L, Guo W, Yang R, Tang X, Ji T. Proposed Scoring System for Evaluating Neurologic Deficit after Sacral Resection: Functional Outcomes of 170 Consecutive Patients. Spine (Phila Pa 1976). 2016;41(7):628-37. doi:10.1097/BRS.0000000000001274. Tang X, Guo W, Yang R, Tang S, Dong S. Use of aortic balloon occlusion to decrease blood loss during sacral tumor resection. J Bone Joint Surg Am. 2010;92(8):1747-53. doi:10.2106/jbjs.I.01333. 李琪, 赵红, 燕太强. 腹主动脉内球囊阻断技术用于骨盆和骶骨肿瘤切除术的研究进展. 临床麻醉学杂志. 2022;38(5):549-52. doi:10.12089/jca.2022.05.020. 唐顺, 董森, 郭卫, 杨荣利. 腹主动脉球囊阻断控制骶骨肿瘤切除术中出血的效果. 中国脊柱脊髓杂志. 2009;19(2):85-9. doi:10.3969/j.issn.1004-406X.2009.02.01. Chen LK, Liu LK, Woo J, Assantachai P, Auyeung TW, Bahyah KS, et al. Sarcopenia in Asia: consensus report of the Asian Working Group for Sarcopenia. J Am Med Dir Assoc. 2014;15(2):95-101. doi:10.1016/j.jamda.2013.11.025. Wang J, Chen Y, He J, Yin C, Xie M. Sarcopenia Predicts Postoperative Complications and Survival of Colorectal Cancer Patients Undergoing Radical Surgery. Br J Hosp Med (Lond). 2024;85(9):1-17. doi:10.12968/hmed.2024.0297. Nagarajan G, Doshi P, Bardeskar NS, Kulkarni A, Punamiya A, Tongaonkar H. Association between sarcopenia and postoperative complications in patients undergoing surgery for gastrointestinal or hepato-pancreatico-biliary cancer. J Surg Oncol. 2023;128(4):682-91. doi:10.1002/jso.27315. Chen WS, Huang YS, Xu LB, Shi MM, Chen XD, Ye GQ, et al. Effects of sarcopenia, hypoalbuminemia, and laparoscopic surgery on postoperative complications in elderly patients with colorectal cancer: A prospective study. Neoplasma. 2020;67(4):922-32. doi:10.4149/neo_2020_190908N882. Coker RH, Wolfe RR. Bedrest and sarcopenia. Curr Opin Clin Nutr Metab Care. 2012;15(1):7-11. doi:10.1097/MCO.0b013e32834da629. Chen F, Adhami M, Tan M, Grodski S, Serpell J, Orr A, et al. Hypotension in Posterior Retroperitoneoscopic Versus Transperitoneal Laparoscopic Adrenalectomy. J Surg Res. 2022;275:87-95. doi:10.1016/j.jss.2022.01.013. Polyzogopoulou E, Amoiridou P, Abraham TP, Ventoulis I. Acute liver injury in COVID-19 patients hospitalized in the intensive care unit: Narrative review. World J Gastroenterol. 2022;28(47):6662-88. doi:10.3748/wjg.v28.i47.6662. James LA, Levin MA, Lin HM, Deiner SG. Association of Preoperative Frailty With Intraoperative Hemodynamic Instability and Postoperative Mortality. Anesth Analg. 2019;128(6):1279-85. doi:10.1213/ane.0000000000004085. Bailey AJ, Lee A, Li HO, Glen P. Intraoperative balloon occlusion of the aorta for blood management in sacral and pelvic tumor resection: A systematic review and meta-analysis. Surg Oncol. 2020;35:156-61. doi:10.1016/j.suronc.2020.08.016. Irahara T, Sato N, Moroe Y, Fukuda R, Iwai Y, Unemoto K. Retrospective study of the effectiveness of Intra-Aortic Balloon Occlusion (IABO) for traumatic haemorrhagic shock. World J Emerg Surg. 2015;10(1):1. doi:10.1186/1749-7922-10-1. Amrock LG, Neuman MD, Lin HM, Deiner S. Can routine preoperative data predict adverse outcomes in the elderly? Development and validation of a simple risk model incorporating a chart-derived frailty score. J Am Coll Surg. 2014;219(4):684-94. doi:10.1016/j.jamcollsurg.2014.04.018. Murray T, Williams D, Lee MJ. Erratum to: Osteoporosis, obesity, and sarcopenia on abdominal CT: a review of epidemiology, diagnostic criteria, and management strategies for the reporting radiologist. Abdom Radiol (NY). 2018;43(5):1281. doi:10.1007/s00261-017-1274-5. Hamaguchi Y, Kaido T, Okumura S, Kobayashi A, Shirai H, Yao S, et al. Proposal for new selection criteria considering pre-transplant muscularity and visceral adiposity in living donor liver transplantation. J Cachexia Sarcopenia Muscle. 2018;9(2):246-54. doi:10.1002/jcsm.12276. Tang X, Guo W, Yang R, Tang S, Ji T. Risk factors for blood loss during sacral tumor resection. Clin Orthop Relat Res. 2009;467(6):1599-604. doi:10.1007/s11999-008-0483-1. Narayan M, Medinilla SP. Fever in the postoperative patient. Emerg Med Clin North Am. 2013;31(4):1045-58. doi:10.1016/j.emc.2013.07.011. 张芳芳, 胡雅静, 黄华勇, 倪锦晖, 尤泽, 常巧玲, et al. 基于CT诊断的肌少症对结直肠癌患者发生手术部位感染的影响因素分析. 中国全科医学. 2022;25(29):3658-63. doi:10.12114/j.issn.1007-9572.2022.0429. Yang J, Zhang T, Feng D, Dai X, Lv T, Wang X, et al. A new diagnostic index for sarcopenia and its association with short-term postoperative complications in patients undergoing surgery for colorectal cancer. Colorectal Dis. 2019;21(5):538-47. doi:10.1111/codi.14558. Silva de Paula N, de Aguiar Bruno K, Azevedo Aredes M, Villaça Chaves G. Sarcopenia and Skeletal Muscle Quality as Predictors of Postoperative Complication and Early Mortality in Gynecologic Cancer. Int J Gynecol Cancer. 2018;28(2):412-20. doi:10.1097/igc.0000000000001157. Zakaria HM, Schultz L, Mossa-Basha F, Griffith B, Chang V. Morphometrics as a predictor of perioperative morbidity after lumbar spine surgery. Neurosurg Focus. 2015;39(4):E5. doi:10.3171/2015.7.Focus15257. Petersen AM, Pedersen BK. The anti-inflammatory effect of exercise. J Appl Physiol (1985). 2005;98(4):1154-62. doi:10.1152/japplphysiol.00164.2004. Scheffer DDL, Latini A. Exercise-induced immune system response: Anti-inflammatory status on peripheral and central organs. Biochim Biophys Acta Mol Basis Dis. 2020;1866(10):165823. doi:10.1016/j.bbadis.2020.165823. Lieffers JR, Bathe OF, Fassbender K, Winget M, Baracos VE. Sarcopenia is associated with postoperative infection and delayed recovery from colorectal cancer resection surgery. Br J Cancer. 2012;107(6):931-6. doi:10.1038/bjc.2012.350. Olmez T, Gulmez S, Karakose E, Ofluoglu CB, Senger AS, Bozkurt H, et al. Relation between Sarcopenia and Surgical Site Infection in Patients Undergoing Gastric Cancer Surgery. Surg Infect (Larchmt). 2021;22(5):551-5. doi:10.1089/sur.2020.211. Lee DY, Shin S. Sarcopenia and Anemia in Elderly Koreans: A Nationwide Population-Based Study. Healthcare (Basel). 2023;11(17). doi:10.3390/healthcare11172428. Levi M, van der Poll T. Inflammation and coagulation. Crit Care Med. 2010;38(2 Suppl):S26-34. doi:10.1097/CCM.0b013e3181c98d21. Conde Díez S, de Las Cuevas Allende R, Conde García E. Anemia of inflammation and iron metabolism in chronic diseases. Rev Clin Esp (Barc). 2024;224(9):598-608. doi:10.1016/j.rceng.2024.09.002. He L, He R, Huang J, Zou C, Fan Y. Impact of frailty on all-cause mortality and major bleeding in patients with atrial fibrillation: A meta-analysis. Ageing Res Rev. 2022;73:101527. doi:10.1016/j.arr.2021.101527. Laviano A. Sarcopenia, biological age and treatment eligibility in patients with cancer. Curr Opin Clin Nutr Metab Care. 2023;26(1):59-63. doi:10.1097/mco.0000000000000888. Tamura T, Sakurai K, Nambara M, Miki Y, Toyokawa T, Kubo N, et al. Adverse Effects of Preoperative Sarcopenia on Postoperative Complications of Patients With Gastric Cancer. Anticancer Res. 2019;39(2):987-92. doi:10.21873/anticanres.13203. 张建, 华琦. 中国老龄化的特征发展趋势与对策. 中国心血管杂志. 2010;15(1):79-80. doi:10.3969/j.issn.1007-5410.2010.01.029. Xu J, Zheng B, Zhang S, Zeng T, Chen H, Zheng W, et al. Effects of preoperative sarcopenia on postoperative complications of minimally invasive oesophagectomy for oesophageal squamous cell carcinoma. J Thorac Dis. 2019;11(6):2535-45. doi:10.21037/jtd.2019.05.55. Shi B, Liu S, Chen J, Liu J, Luo Y, Long L, et al. Sarcopenia is Associated with Perioperative Outcomes in Gastric Cancer Patients Undergoing Gastrectomy. Ann Nutr Metab. 2019;75(4):213-22. doi:10.1159/000504283. Ryan AM, Prado CM, Sullivan ES, Power DG, Daly LE. Effects of weight loss and sarcopenia on response to chemotherapy, quality of life, and survival. Nutrition. 2019;67-68:110539. doi:10.1016/j.nut.2019.06.020. van Vugt JL, Braam HJ, van Oudheusden TR, Vestering A, Bollen TL, Wiezer MJ, et al. Erratum to: Skeletal Muscle Depletion is Associated with Severe Postoperative Complications in Patients Undergoing Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Carcinomatosis of Colorectal Cancer. Ann Surg Oncol. 2015;22 Suppl 3:S1610. doi:10.1245/s10434-015-4467-6. Anandavadivelan P, Brismar TB, Nilsson M, Johar AM, Martin L. Sarcopenic obesity: A probable risk factor for dose limiting toxicity during neo-adjuvant chemotherapy in oesophageal cancer patients. Clin Nutr. 2016;35(3):724-30. doi:10.1016/j.clnu.2015.05.011. Barret M, Antoun S, Dalban C, Malka D, Mansourbakht T, Zaanan A, et al. Sarcopenia is linked to treatment toxicity in patients with metastatic colorectal cancer. Nutr Cancer. 2014;66(4):583-9. doi:10.1080/01635581.2014.894103. Benedek Z, Todor-Boér S, Kocsis L, Bauer O, Suciu N, Coroș MF. Psoas Muscle Index Defined by Computer Tomography Predicts the Presence of Postoperative Complications in Colorectal Cancer Surgery. Medicina (Kaunas). 2021;57(5). doi:10.3390/medicina57050472. Picca A, Coelho-Junior HJ, Calvani R, Marzetti E, Vetrano DL. Biomarkers shared by frailty and sarcopenia in older adults: A systematic review and meta-analysis. Ageing Res Rev. 2022;73:101530. doi:10.1016/j.arr.2021.101530. Harris AB, Badin D, Hegde V, Oni JK, Sterling RS, Khanuja HS. Preoperative Anemia is an Independent Risk Factor for Increased Complications and Mortalities After Total Knee Arthroplasty Regardless of Postoperative Transfusions. J Arthroplasty. 2023;38(7 Suppl 2):S177-s81. doi:10.1016/j.arth.2023.01.042. Chen X, Shen Y, Hou L, Yang B, Dong B, Hao Q. Sarcopenia index based on serum creatinine and cystatin C predicts the risk of postoperative complications following hip fracture surgery in older adults. BMC Geriatr. 2021;21(1):541. doi:10.1186/s12877-021-02522-1. Hu Y, Wang L, Liu H, Yang K, Wang S, Zhang X, et al. Association of preoperative hypoprotein malnutrition with spinal postoperative complications and other conditions: A systematic review and meta-analysis. Clin Nutr ESPEN. 2023;57:448-58. doi:10.1016/j.clnesp.2023.07.083. Li Q, Dong S, Yan T, Zhao H. Association between intraoperative fluid overload and postoperative debridement in major sacrum tumor resection: A propensity score matching study. Medicine (Baltimore). 2022;101(40):e30947. doi:10.1097/md.0000000000030947. Footnotes Table 1 . Demographic and Surgical Data Tables Table 1. Demographic and Surgical Data Sarcopenia Group (n=96) Control Group (n=125) Statistical value P-Value L3 SMI 30.99 (8.36) 43.47 (11.12) -10.098 <0.001* Male Gender (n(%)) 53 (55.2%) 72 (57.6%) 0.126 0.722 Age (years) 50 (30) 44 (24) -1.084 0.278 Age≥60 (n(%)) 25 (26%) 15 (12%) 7.222 0.007* BMI (km/cm²) 21.3 ± 3.2 24.1 ± 3.0 -6.623 <0.001* ASA classification (n) 1.192 0.551 I 21 (21.9%) 30 (24%) II 67 (69.8%) 89 (71.2%) III 8 (8.3%) 6 (4.8%) Hypertension (n(%)) 7 (7.3%) 11(8.8%) 0.165 0.684 Diabetes (n(%)) 3 (3.1%) 2 (1.6%) 0.090 0.765 Coronary artery disease (n(%)) / / / / Respiratory disease (n(%)) 12 (12.5%) 15 (12%) 0.013 0.910 Diagnosis (n(%)) Benign (n(%)) 29 (30.2%) 57 (45.6%) 5.411 0.020* Giant cell tumor (n) 18 24 Aneurysmal bone cyst (n) 1 0 Neurofibroma (n) 4 6 Schwannoma (n) 5 13 Hemangioma (n) 0 4 Myxoma (n) 1 1 Solitary fibroadenoma (n) 0 3 Ependymoma (n) 0 1 Diagnosed as benign (n) 0 5 Malignant (n(%)) 53 (55.2%) 44 (35.2%) 8.827 0.003* Chordoma (n) 14 21 Osteosarcoma (n) 9 1 Chondrosarcoma (n) 7 10 Ewing’s sarcoma (n) 4 2 Diagnosed as malignant (n) 15 10 Metastatic (n(%)) 14 (14.6%) 24 (19.2%) 0.813 0.367 Digestive tract tumor (n) 1 2 Urinary tract tumor (n) 4 3 Mammary carcinoma (n) 0 2 Thyroid tumor (n) 3 2 Liver cancer (n) 2 4 Lung cancer (n) 3 5 Cervical cancer (n) 0 2 PEComa (n) 1 1 Adipose tissue (n) 0 2 Bone tissue (n) 0 1 Recurrent tumor (n(%)) 15 (15.6%) 20 (16%) 0.006 0.940 Surgical approach Total En bloc (n(%)) 13 (13.5%) 11 (8.8%) 1.261 0.261 Posterior (n(%)) 69 ( 71.9%) 107 (85.6%) 6.308 0.012* Anterior and posterior (n(%)) 14 (14.6%) 7 (5.6%) 5.096 0.024* Duration of surgery (min) 184 (78) 177 (69) -1.656 0.098 Duration of anesthesia(min) 270 (86) 245 (81) -1.795 0.073 Duration of Aortic Occlusion (min) 70 (46) 67 (41) -0.729 0.466 Preoperative chemotherapy (n(%)) 28 (29.2%) 22 (17.6%) 4.150 0.042* Reoperation (n(%)) 21 (21.9%) 24 (19.2) 0.240 0.624 Preoperative analgesics (n(%)) 52 (54.2%) 55 (44%) 2.247 0.134 Data shown in mean ± SD, median (IQR), n (%). Abbreviations：IQR = interquartile range, SD = standard deviation , ASA=American Society of Anesthesiologists, BMI (Body mass index) = weight (in kg)/ height^2 (in m^2), SMI=skeletal muscle mass index ,calculated by normalizing skeletal muscle area at lumbar 3 level to the square of the patient’s height (cm^2/m^2) . * P < 0.05. Table 2. Anesthesia Management and Postoperative Outcomes Sarcopenia Group (n=96) Control Group (n=125) Statistical value P-Value Blood Loss (mL) 1175 (788) 1000 (675) -1.618 0.106 Extensive Blood Loss (>2000mL) (n(%)) 16 (16.7%) 6 (4.8%) 8.530 0.006* Volume of Infused CRC (mL) 780 (520) 520 (260) -1.796 0.072 Volume of Infused FFP (mL) 400 (550) 400 (400) -2.164 0.030* Volume of fluid infusion (mL) 4680 (2300) 4320 (1461) -2.219 0.026* Urine Output (mL) 825 (775) 650 (625) -2.208 0.027* Fluid excess (mL/kg) 45.2 (26.6) 37.2 (19.0) -1.236 0.216 Fluid overload (n(%)) 63 (65.5%) 61 (48.8%) 6.242 0.012* Preoperative hemoglobin (g/L) 130 (24) 137 (21) -3.356 0.001* Postoperative hemoglobin (g/L) 114 (24) 118 (22) -2.244 0.025* Preoperative hematocrit (%) 37.5 ± 5.7 40.0 ± 4.7 -3.640 <0.001* Postoperative hematocrit (%) 33.7 ± 4.7 35.0 ± 4.4 -2.080 0.039* Preoperative albumin (g/L) 40.2 (4.6) 41.6 (4.2) -3.071 0.002* Postoperative albumin (g/L) 32.8 (4.9) 34.1 (4.4) -2.722 0.006* Preoperative blood creatinine (μmoI/L) 58 (21) 65 (23) -3.390 0.001* Postoperative blood creatinine (μmoI/L) 51(20) 59 (21) -3.425 0.001* Preoperative hypoalbuminemia (n(%)) 5 (5.2%) 5 (4.0%) 0.184 0.668 Postoperative hypoalbuminemia (n(%)) 71 (74%) 77 (61.6%) 3.749 0.054 Preoperative anemia (n(%)) 22 (22.9%) 12 (9.6%) 7.397 0.007* Postoperative anemia (n(%)) 49 (51%) 51 (40.8%) 2.299 0.129 Length of Stay (days) 21 (10) 20 (8) -0.901 0.367 Prolonged hospital stay (n(%)) 15 (15.6%) 13 (10.4%) 1.340 0.247 Volume of drainage (ml) 1930 (2006) 1973 (1653) -0.106 0.915 Preoperative CFI(n(%)) 26.422 <0.001* 0 49 (51%) 103(82.4%) 1 36(37.5%) 19(15.2%) 2 10(10.4%) 2(1.6%) 3 1(1%) 1(0.8%) Preoperative CFI≥2 (n(%)) 11 (11.5%) 3 (2.4) 7.509 0.006* Postoperative CFI (n(%)) 22.861 <0.001* 0 14(14.6%) 39(31.2%) 1 32(33.3%) 48(38.4%) 2 35(36.5%) 36(28.8%) 3 14(14.6%) 1(0.8%) 4 1(1.0%) 1(0.8%) Postoperative CFI≥2 (n(%)) 50 (52.1%) 38 (30.4%) 0.001* Data shown in mean ± SD, median (IQR), n (%). Abbreviations：IQR = interquartile range, SD = standard deviation, CRC = concentrate red cell, FFP = frozen fresh plasma, L3 SMI= Skeletal muscle area [(L3 muscle mass in c‌m^2 )/ (height in m) ^2. CFI=chart-derived frailty index, The CFI is represented by the sum of five parameters , which includes age, preoperative body mass index (BMI), hematocrit, albumin, and serum creatinine, Fluid excess=Fluid infused (including CRC and FFP)-(Blood loss + Urine output)/Body weight, Fluid overload=fluid excess > 38.5 mL/kg, Prolonged hospital stay was defined as Hospital stay longer than 28 days, hypoalbuminemia was defined as albumin < 30 g/L. Anemia was defined as adult male hemoglobin is less than 120g/L, and adult female hemoglobin is less than 110g/L. * P<0.05 Table 3. Postoperative complication Sarcopenia Group (n=96) Control Group (n=125) Statistical value P-Value Clavien-Dindo classification grade 1(n(%)) 35 (36.5%) 37 (29.6%) 1.163 0.281 Fever (n(%)) 35 (36.5%) 37 (29.6%) 1.163 0.281 Clavien-Dindo classification grade 2(n(%)) 29 (30.2%) 21 (16.8%) 5.576 0.018* Postoperative blood transfusion (n(%)) 27 (28.1%) 21 (16.8%) 4.096 0.043* Pulmonary complications grade 2 (n) 2（2.1%） 0（0） 2.628 0.105 Clavien-Dindo classification grade 3(n(%)) 18 (18.8%) 11 (8.8%) 4.715 0.030* Debridement (n(%)) 9 (9.4%） 3 (2.4%) 5.144 0.023* Cerebrospinal fluid leak (n(%)) 2 (2.1%) 4 (3.2%) 0.256 0.613 Pulmonary complications grade 3 (n) 9（9.4%） 4（3.2%） 3.740 0.053 Clavien-Dindo classification grade 4 (n(%)) 8 (8.3%) 3 (2.4%) 4.042 0.044* ICU admittance (n (%)) 7 (7.3%) 3 (2.4%) 3.007 0.083 Pulmonary complications grade 4 (n) 1（1%） 2（1.6%） 0.126 0.772 Clavien-Dindo classification grades ≥2 41(42.7%) 32(25.6%) 7.185 0.007* Data shown in mean ± SD, median (IQR), n (%). Abbreviations: IQR = interquartile range, SD = standard deviation, ICU = intensive care unit; Postoperative fever was defined as postoperative temperature≥38°C; Clavien-Dindo classification grade1:Postoperative fever; Clavien-Dindo classification grade2:Postoperative blood transfusion, pulmonary complications grade grade 2 ; Clavien-Dindo classification grade3:Postoperative debridement, cerebrospinal fluid leakage, and pulmonary complications grade 3； Clavien-Dindo classification grade 4:postoperative admission to ICU,pulmonary complications grade 4. * P<0.05 Table 4. Univariate analysis of Clavien-Dindo classification grades ≥ 2 Complication Group (n=73) Control Group (n=148) Statistical value P-Value Age (years) 48（24） 44（25） -0.824 0.410 Age≥60 (n(%)) 16（21.9%） 24（16.2%） 1.072 0.300 ASA classification (n) 0.115 0.944 I (n(%)) 16（21.9%） 35（23.6%） II (n(%)) 52（71.2%） 104（70.3%） III (n(%)) 5（6.8%） 9（6.1%） BMI (km/cm²) 22.5 ± 3.6 23.1 ± 3.2 3.215 0.257 Blood Loss (mL) 1000（700） 1000（788） -0.774 0.439 Fluid overload (n(%)) 43（58.9%） 81（54.7%） 0.346 0.556 Duration of surgery (min) 180（81） 179（74） -0.398 0.691 Duration of anesthesia (min) 254（95） 254（78） -0.507 0.612 Preoperative anemia (n(%)) 15（20.5%） 19（12.8%） 2.232 0.135 Preoperative albumin (g/L) 40.2（4.5） 41.5（4.6） 0.002 0.056 Preoperative hypoalbuminemia (n(%)) 6（8.2%） 4（2.7%） 3.444 0.063 Preoperative CFI(n(%)) 6.486 0.090 0 43（58.9%） 109（73.6%） 1 22（30.1%） 33（22.3%） 2 7（9.6%） 5（3.4%） 3 1（1.4%） 1（0.7%） Reoperation (n(%)) 17（23.3%） 28（18.9%） 0.575 0.448 Preoperative chemotherapy (n(%)) 17（23.3%） 33（22.3%） 0.027 0.869 Sarcopenia (n(%)) 41（56.2%） 55（37.2%） 7.185 0.007* FCM>15% 5（5） 3（3） -3.210 0.001* Data shown in mean ± SD, median (IQR), n (%). Abbreviations: IQR = interquartile range, SD = standard deviation, FCM=fractional change in mean arterial pressure, CFI=chart-derived frailty index, The CFI is represented by the sum of five parameters , which includes age, preoperative body mass index (BMI), hematocrit, albumin, and serum creatinine. Fluid excess=Fluid infused (including CRC and FFP)-(Blood loss + Urine output)/Body weight, Fluid overload=fluid excess > 38.5 mL/kg, Hypoalbuminemia was defined as albumin < 30 g/L. Anemia was defined as adult male hemoglobin is less than 120g/L, and adult female hemoglobin is less than 110g/L. * P<0.05 Table 5. Mediation effect analysis Variable Clavien-Dindo classification grades ≥ 2 FCM＞15% Clavien-Dindo classification grades ≥ 2 Constant 0.256** 0.568** 0.123* Sarcopenia 0.171** 0.953* 0.136* FCM＞15% 0.037** R² 0.033 0.027 0.082 Adjustment R² 0.028 0.023 0.072 F-value 1.219** 1.219** 2.218** Abbreviations：FCM= fractional change in mean arterial pressure Model effect Effect size Boot SE Bootstrap95%CI Effect proportion Total effect 0.171 0.063 0.047-0.295 100.0% Direct effect 0.136 0.062 0.013-0.258 20.757% Total indirect effect 0.036 0.021 0.005-0.085 79.243% Abbreviations：95% CI=95% confidence interval Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6595292","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":471723840,"identity":"56fdbb74-c74d-421c-aa18-d25d50d507e6","order_by":0,"name":"Jiaxing Zheng","email":"","orcid":"","institution":"Peking University People's Hospital","correspondingAuthor":false,"prefix":"","firstName":"Jiaxing","middleName":"","lastName":"Zheng","suffix":""},{"id":471723842,"identity":"202492a2-936c-4c08-887d-7486746ee1ae","order_by":1,"name":"Bei An","email":"","orcid":"","institution":"Peking University People's Hospital","correspondingAuthor":false,"prefix":"","firstName":"Bei","middleName":"","lastName":"An","suffix":""},{"id":471723843,"identity":"a24df967-8876-4c7d-a52a-78ddb0f02288","order_by":2,"name":"Hong Zhao","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABD0lEQVRIiWNgGAWjYLCCBDDiATFtGCQYGNiADGaitaQRqYUBoeUwYS267cefSTxgqMvjb+89+Ljg1/k8yRm5xx4wVFgnNrCfPYBNi9mZhDSJBAa2Yokz55KNZ/bdLpaWyEs3YDiTntjAk5eAVcuBhGNALTyJDTdyzKR5e24nzpPIMZNgbDuc2CDBY4BVy/mHbUAtEonzIVrOQbX8w6PlRjIbUItB4gaQFp4fBxJng7U04NPyjNkigSEhceOZM8bGvA3JxZI974C+O5Zu3MaTg8Nh6Q9v/mCoS5x3vMfwMc8fuzyJ47nHJD7UWMv2s5/BqgUMGP/BGG3QCAIFFRtO9SjgDzxOR8EoGAWjYBTAAQAMO1/J+WkaAwAAAABJRU5ErkJggg==","orcid":"","institution":"Peking University People's Hospital","correspondingAuthor":true,"prefix":"","firstName":"Hong","middleName":"","lastName":"Zhao","suffix":""},{"id":471723844,"identity":"dfbb8643-e6d8-43c4-b379-f0d18fb27d5a","order_by":3,"name":"Yi Feng","email":"","orcid":"","institution":"Peking University People's Hospital","correspondingAuthor":false,"prefix":"","firstName":"Yi","middleName":"","lastName":"Feng","suffix":""}],"badges":[],"createdAt":"2025-05-05 14:23:29","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6595292/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6595292/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":84869525,"identity":"3bad6869-6b6a-4380-aeb8-1e3f4ed91c21","added_by":"auto","created_at":"2025-06-18 08:50:43","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":58457,"visible":true,"origin":"","legend":"\u003cp\u003eFlow Chart\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6595292/v1/38ff6ce2a8fbf9cfa74a0fe1.png"},{"id":84870609,"identity":"78f741a7-a4c8-45a4-afee-39811db828e0","added_by":"auto","created_at":"2025-06-18 08:58:43","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":54370,"visible":true,"origin":"","legend":"\u003cp\u003eComparison of postoperative complications between the two groups\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-6595292/v1/d1f01622608bf6c833663d3b.png"},{"id":84869527,"identity":"157712fb-2935-460e-9931-96ae5c73cdc6","added_by":"auto","created_at":"2025-06-18 08:50:43","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":54806,"visible":true,"origin":"","legend":"\u003cp\u003eMultivariate Logistic Regression Forest Plot\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-6595292/v1/102f2d448112910c46d9dbb5.png"},{"id":84870610,"identity":"3e46e157-258c-460d-a03f-858044c8bbb3","added_by":"auto","created_at":"2025-06-18 08:58:43","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":50529,"visible":true,"origin":"","legend":"\u003cp\u003eThe predictive ability of sarcopenia and FCM \u0026gt; 15% for Clavien-Dindo classification grades ≥ 2\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-6595292/v1/d3ec39b2f88465f051b354fd.png"},{"id":84870611,"identity":"73566896-a8b9-49c3-8139-0ff72ddde807","added_by":"auto","created_at":"2025-06-18 08:58:43","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":27706,"visible":true,"origin":"","legend":"\u003cp\u003eMediation Effect Diagram\u003c/p\u003e","description":"","filename":"5.png","url":"https://assets-eu.researchsquare.com/files/rs-6595292/v1/146eaf4d52c584371ab12e0b.png"},{"id":84871272,"identity":"b56ac4ae-0ecc-4671-b1a4-014d56a5be4d","added_by":"auto","created_at":"2025-06-18 09:06:44","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1453087,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6595292/v1/c2262a33-3c8d-4f60-9a60-ac295d01094a.pdf"},{"id":84870612,"identity":"f4e5dd31-5ad7-4660-aac3-bccd0e5f93ff","added_by":"auto","created_at":"2025-06-18 08:58:43","extension":"xls","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":160052,"visible":true,"origin":"","legend":"","description":"","filename":"Attachment1.xls","url":"https://assets-eu.researchsquare.com/files/rs-6595292/v1/c680811f10d0869d3ef97547.xls"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eEffect of sarcopenia in patients undergoing sacrum tumor resection with intra-aortic balloon occlusion\u003cstrong\u003e: \u003c/strong\u003ea retrospective cohort study\u003c/p\u003e","fulltext":[{"header":"Background","content":"\u003cp\u003eSacral tumors pose a serious threat to human health, and surgical resection is the primary treatment method. Due to the complex anatomical structure of the sacral region, significant intraoperative blood loss, and the high malignancy of the tumors, the incidence of postoperative complications is high, severely affecting patient prognosis(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). To reduce intraoperative bleeding, shorten the operation time and bring the possibility of complete tumor resection, the intra-arterial balloon occlusion (IABO) technique is currently commonly used to temporarily block the abdominal aorta for the operation. There are many studies on IABO in sacral resection surgery. The common view is that this technique can reduce intraoperative bleeding and shorten the operation time, and it is a safe and effective way to control intraoperative bleeding(\u003cspan additionalcitationids=\"CR3\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Nevertheless, sacral tumor patients still experience a high rate of postoperative complications and the effect of sarcopenia on the prognosis of these patients should be investigated.\u003c/p\u003e \u003cp\u003eSarcopenia is a syndrome characterized by the progressive and systemic loss of skeletal muscle mass and strength. It is clinically shown as low muscle mass, low muscle strength, and/or low physical performance(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e), which can lead to more postoperative complications. Studies have confirmed that the prevalence of sarcopenia is high among the elderly, bedridden individuals, and people who are immobilized for a long time(\u003cspan additionalcitationids=\"CR7 CR8\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e), as well as patients undergoing surgery for malignant tumors. Additionally, patients with sacral tumors are especially at risk. Patients with sarcopenia usually have insufficient metabolic reserves, decreased immune function, reduced activity levels, enhanced inflammatory responses, and poor nutritional status, which affects wound healing and recovery of bodily functions, thus leading to complications.\u003c/p\u003e \u003cp\u003eIABO aims to control bleeding by blocking aortic blood flow in specific segments through interventional techniques. However, these hemodynamic fluctuations can lead to physiological effects such as organ ischemia, thromboembolism, and ischemia-reperfusion, which could negatively impact postoperative recovery(\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). These effects, when combined with existing sarcopenia, could work together to impair muscle regeneration and the body's inflammatory response. Previous studies have confirmed that intraoperative hemodynamic instability is associated with postoperative complications(\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). For patients undergoing sacral tumor resection with IABO, first, IABO is used in surgeries with a high risk of bleeding(\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e); second, IABO is characterized by a rapid change in afterload and organ perfusion pressure, with trauma and risk coexisting during its use(\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e); third, sarcopenia often occurs in patients with tumors of higher malignancy, making surgery challenging. So, we speculate that intraoperative hemodynamic instability might mediate how sarcopenia affects postoperative complications.\u003c/p\u003e \u003cp\u003eIn this retrospective cohort study, we collected sacrum tumor data in 3 years, aiming to investigate the effect of sarcopenia on postoperative complications in patients undergoing sacral tumor surgery with IABO, and the mediating role of hemodynamic instability.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003eWe used the anesthesia database of Peking University People's Hospital to retrieve all patients who underwent sacral tumor resection with IABO under general anesthesia from January 1, 2018, to September 28, 2021 (ages 14\u0026ndash;76). Inclusion criteria required patients to be aged\u0026thinsp;\u0026ge;\u0026thinsp;14 years. Exclusion criteria included non-general anesthesia, sacral debridement, sacral internal fixation removal, actual non-use of IABO during surgery, and absence of pelvic-abdominal computed tomography (CT) scan results. Anesthesia data, surgical data, pathological diagnoses, length of hospital stay, and postoperative complications were collected by reviewing anesthesia records and medical charts. (The original data can be found in Attachment 1)\u003c/p\u003e \u003cp\u003ePatients were divided into Sarcopenia group or control group according to skeletal muscle index (SMI) at the L3 acquired through preoperative CT. Clinical outcomes were compared between groups. The study protocol was approved by the Ethics Committee of Peking University People\u0026rsquo;s Hospital, Beijing, China, which waived the requirement for informed consent because of the retrospective design. This article complied with the STROBE guidelines for a retrospective study.\u003c/p\u003e \u003cp\u003eUsing the method from Amrock et al., we calculate the Chart-derived frailty index (CFI) for each patient, which includes five indicators: age\u0026thinsp;\u0026gt;\u0026thinsp;70, Body mass index (BMI)\u0026thinsp;\u0026lt;\u0026thinsp;18.5 kg/m\u0026sup2;, hematocrit\u0026thinsp;\u0026lt;\u0026thinsp;35%, albumin\u0026thinsp;\u0026lt;\u0026thinsp;34 g/L, and creatinine\u0026thinsp;\u0026gt;\u0026thinsp;176.8 \u0026micro;mol/L (2.0 mg/dL), where each indicator is worth 1 point, and the total score is just the sum of the five indicators(\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e).\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eMeasurement of Muscle Mass and Assessment of Sarcopenia\u003c/h2\u003e \u003cp\u003eThe skeletal muscle index (SMI) at the L3 plane was obtained by normalizing with the patient's height (in square meters) ((cm\u0026sup2;/m\u0026sup2;) (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). Based on the characteristics of the Asian population, the diagnostic cutoff values for sarcopenia were selected: male SMI\u0026thinsp;\u0026le;\u0026thinsp;40.31 cm\u0026sup2;/m\u0026sup2;, female SMI\u0026thinsp;\u0026le;\u0026thinsp;30.88 cm\u0026sup2;/m\u0026sup2; (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). According to these cutoff values, we divided the patients into the sarcopenia and the control group.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eAnesthesia management and IABO application\u003c/h3\u003e\n\u003cp\u003eAll patients underwent tracheal intubation and general anesthesia, with continuous monitoring of invasive arterial blood pressure and central venous pressure during the procedure, maintaining a systolic blood pressure\u0026thinsp;\u0026gt;\u0026thinsp;90 mmHg to balance organ perfusion and bleeding risk. The application of IABO was based on preoperative CT confirming a tumor volume exceeding 200 cm\u003csup\u003e3\u003c/sup\u003e, with rich blood supply to the tumor or invasion of the S2-S3 intervertebral disc space(\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). All patients received temporary IABO. After anesthesia induction, a dual-lumen balloon (MAXILD; Cordis, Johnson \u0026amp; Johnson, Bridgewater, New Jersey) was inserted percutaneously into the patient's right femoral artery and advanced to the abdominal aorta. Once the puncture was done, an X-ray C-arm was used to find the balloon's position.\u003c/p\u003e\n\u003ch3\u003eCalculation of Intraoperative Hemodynamic Variability\u003c/h3\u003e\n\u003cp\u003eInvasive blood pressure was recorded every 10 seconds through a radial artery during the surgery in the Anesthesia Information Management System (AIMS) and data were exported for further analysis.\u003c/p\u003e \u003cp\u003eHemodynamic fluctuation was represented as fractional change in median MAP (FCM), which was calculated based on the absolute change in MAP between consecutive 5-minute intervals. The median MAP was calculated over 5-minute intervals throughout the procedure. The fractional change in median MAP was determined by subtracting the median MAP of the following 5 minutes from that of the preceding 5 minutes, then dividing by the median MAP of the preceding interval. Number of FCM episodes (in absolute values) exceeding a prespecified threshold of \u0026gt;\u0026thinsp;0.05, 0.10, 0.15, 0.20 and 0.25 were calculated. (Select the first result that demonstrates statistical significance at a significance level of 0.05 as the threshold)\u003c/p\u003e\n\u003ch3\u003eClinical Outcomes\u003c/h3\u003e\n\u003cp\u003eThe primary outcome of this study is the incidence of postoperative complications of grade 2 or higher in patients.\u003c/p\u003e \u003cp\u003eAccording to the Clavien-Dindo classification, grade 1 includes postoperative fever (temperature\u0026thinsp;\u0026ge;\u0026thinsp;38 degrees(\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e)), grade 2 includes postoperative blood transfusion, pulmonary complications grade 2, grade 3 includes postoperative debridement, postoperative cerebrospinal fluid leak, pulmonary complications grade 3, grade 4 includes postoperative admission to the intensive care unit (ICU), pulmonary complications grade 4, and grade 5 is death. Clavien-Dindo classification grades\u0026thinsp;\u0026ge;\u0026thinsp;2 following sacral tumor surgery are defined as a composite outcome that includes postoperative blood transfusion, postoperative debridement, cerebrospinal fluid leakage, postoperative admission to the ICU, and pulmonary complications grade 2 and above.\u003c/p\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eStatistical analysis was performed using SPSS software (version 27.0, IBM SPSS Statistics, Chicago, Illinois, USA). The normal distribution of different variables was tested using the Kolmogorov-Smirnov test. Normally distributed continuous data were expressed as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (x\u0026thinsp;\u0026plusmn;\u0026thinsp;s), and intergroup comparisons were conducted using independent t-tests. Non-normally distributed continuous data were expressed as median (M) and interquartile range (IQR), with intergroup comparisons performed using the Mann-Whitney U test. Categorical data comparisons were conducted using the χ2 test or Fisher's exact probability test. A P value of \u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e \u003cp\u003eMultivariate logistic regression was adopted to identify risk factors for Clavien-Dindo classification grades\u0026thinsp;\u0026ge;\u0026thinsp;2.\u003c/p\u003e \u003cp\u003eThe impact of sarcopenia on Clavien-Dindo classification grades\u0026thinsp;\u0026ge;\u0026thinsp;2 is at least partially mediated by intraoperative hemodynamic instability, and three conditions must be met: 1. Sarcopenia must necessarily affect the occurrence of fractional change in mean arterial pressure(FCM) \u0026gt; 15%; 2. The occurrence of FCM\u0026thinsp;\u0026gt;\u0026thinsp;15% must influence postoperative complications and be independent of the effect of sarcopenia; 3. The mediating effect must be significant. Mediation effect analysis was conducted using SPSS Bootstrap, the dependent variable is set as Clavien-Dindo classification grades\u0026thinsp;\u0026ge;\u0026thinsp;2, the independent variable as sarcopenia, and the mediating variable as FCM\u0026thinsp;\u0026gt;\u0026thinsp;15%. The percentile bootstrap method is used to obtain a 95% confidence interval to assess the mediating effect.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eWe screened a total of 355 patients, and after reviewing all their medical records, 134 patients were excluded because the IABO not used during the actual surgery (n=49), the anesthesia method was local anesthesia (n=7), the anesthesia method was monitored anesthesia (n=7), the surgical method was sacral debridement (n=4), sacral internal fixation removal (n=1), and there were no CT results (n=66). Finally, 221 patients who underwent sacrectomy were included in this study. A total of 221 patients were included in this study, with 96 patients in sarcopenia group and 125 patients in control group. (Figure 1 )\u003c/p\u003e\n\u003cp\u003ePatients in Sarcopenia group had significantly lower BMI, more patients receiving preoperative chemotherapy, and more patients were more than 60 years of old, and more patients had malignant tumor, compared with patients in control group. In terms of surgical approach, both groups primarily underwent posterior approach resection, but the sarcopenia group had a significantly higher rate of combined anterior and posterior approach resection compared to the control group. There were no differences between the two groups in terms of gender, American society of Aneshesiologists (ASA) classification, underlying diseases, duration of surgery, duration of anesthesia, IABO block time, or secondary surgeries (p \u0026gt; 0.05). (Table 1\u003csup\u003e[1]\u003c/sup\u003e)\u003c/p\u003e\n\u003cp\u003eThe results of the anesthesia data analysis show that the proportion of massive bleeding(\u0026gt;2000mL) i.e. in the sarcopenia group was significantly higher (16/96 (16.7%) vs 6/125 (4.8%), p=0.006) . The intraoperative plasma input volume, fluid input volume, urine output, and fluid overload ratio were all significantly higher than in the control group. The CFI related indicators（albumin, hematocrit, BMI, and creatinine）are lower among those with sarcopenia group(p\u0026lt;0.001). Regarding intraoperative hemodynamic instability, the minimum occurrence was 0 times and the maximum was 14 times, with the sarcopenia group experiencing a higher number of hemodynamic instability events (4(4) vs 3(4), p=0.008). There were no differences in hospital stay duration, prolonged hospital stay (hospital stay longer than 28 days) or wound drainage volume between the two groups (p\u0026gt;0.05). (Table 2)\u003c/p\u003e\n\u003cp\u003eThe Clavien-Dindo classification shows that the sarcopenia group has a significantly higher rate of Clavien-Dindo classification grades \u0026ge; 2 for patients in the sarcopenia group compared to the control group(p=0.007). (Figure 2)The incidence of postoperative fever (body temperature \u0026ge; 38\u0026deg;C) i.e. Clavien-Dindo grade 1 complication, in the sarcopenia group was 36.5% (35/96), vs. 29.6% (37/125) in the control group, and there was no statistical difference between groups (p=0.281). The incidence of postoperative blood transfusion i.e. Clavien-Dindo grade 2 complication, in the sarcopenia group was 28.1% (27/96), vs. 16.8% (21/125) in the control group, and there was a statistical difference between groups (p=0.043).The incidence of pulmonary complications grade 2 i.e. Clavien-Dindo grade 2 complication, in the sarcopenia group was 2.1% (2/96), vs. 0 in the control group, and there was no statistical difference between groups (p=0.105).The incidence of debridement i.e. Clavien-Dindo grade 3 complication, in the sarcopenia group was 9.4% (9/96), vs. 2.4%(3/125) in the control group, and there was a statistical difference between groups (p=0.023).The incidence of cerebrospinal fluid leak i.e. Clavien-Dindo grade 3 complication, in the sarcopenia group was 2.1% (2/96), vs. 3.2%(4/125) in the control group, and there was no statistical difference between groups (p=0.613).The incidence of pulmonary complications grade 3 i.e. Clavien-Dindo grade 3 complication, in the sarcopenia group was 9.4% (9/96), vs. 3.2%(4/125) in the control group, and there was no statistical difference between groups (p=0.053).The incidence of ICU admittance i.e. Clavien-Dindo grade 4 complication, in the sarcopenia group was 7.3% (7/96), vs. 2.4%(3/125) in the control group, and there was no statistical difference between groups (p=0.083).The incidence of pulmonary complications grade 4 \u0026nbsp;i.e. Clavien-Dindo grade 4 complication, in the sarcopenia group was 1% (1/96), vs. 1.6%(2/125) in the control group, and there was no statistical difference between groups (p=0.772). (Table 3)\u003c/p\u003e\n\u003cp\u003eDue to the statistical differences in complication rates between the two groups, we looked into potential factors related to Clavien-Dindo classification grades \u0026ge; 2. In the univariate analysis, we found that sarcopenia and FCM \u0026gt; 15% had p-values less than 0.05, while the p-values for preoperative albumin and low preoperative albumin were near 0.05 (Table 4). The multivariate logistic regression results showed that sarcopenia (OR: 1.847; 95% CI: 1.008-3.383; p = 0.047) and FCM\u0026gt; 15% (OR: 1.190; 95% CI: 1.037-1.320; p = 0.001) were independent risk factors for Clavien-Dindo classification grades \u0026ge; 2.(Figure 3) To assess the predictive ability of sarcopenia and FCM \u0026gt;15% for Clavien-Dindo classification grades \u0026ge; 2, we plotted the ROC curve and calculated the area under the curve (AUC), with the AUC for sarcopenia and FCM \u0026gt;15% at 0.656 (95% CI: 0.574-0.737). (Figure 4) The results of the mediation effect analysis show that the direct effect ratio is 20.76%, which means that hemodynamic instability acts as a partial mediator in the occurrence of Clavien-Dindo classification grades \u0026ge; 2 associated with sarcopenia. (Table 5 and Figure 5).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn this study, we explored for the first time the impact of sarcopenia on postoperative complications in patients undergoing sacral tumor resection with IABO. The results indicate that sarcopenia increases the risk of postoperative complications and is an independent risk factor for these complications. We found that patients in the sarcopenia group had a significantly higher incidence of Clavien-Dindo classification grades\u0026thinsp;\u0026ge;\u0026thinsp;2, postoperative blood transfusions, and postoperative debridement compared to the control group. Furthermore, hemodynamic instability plays a mediating role between sarcopenia and Clavien-Dindo classification grades\u0026thinsp;\u0026ge;\u0026thinsp;2.\u003c/p\u003e \u003cp\u003eThis study found that the incidence of Clavien-Dindo classification grades\u0026thinsp;\u0026ge;\u0026thinsp;2 is significantly increased in patients with sarcopenia, indicating the important impact of sarcopenia on postoperative complications, which is consistent with previous studies showing that sarcopenia is associated with an increased risk of various postoperative complications(\u003cspan additionalcitationids=\"CR21\" citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn the analysis of specific postoperative complications, the incidence of debridement due to wound infection in the sarcopenia group was significantly higher than that in the control group, which is consistent with a retrospective study (n\u0026thinsp;=\u0026thinsp;395) that identified reduced lumbar muscle area as an independent risk factor for complications such as wound infection after spinal surgery (adjusted OR\u0026thinsp;=\u0026thinsp;2.42, 95% CI 1.17\u0026ndash;5.01, p\u0026thinsp;=\u0026thinsp;0.016). After controlling for age, coronary artery disease, and smoking status, it also confirmed the conclusion that patients with lower lumbar muscle area have an increased risk of debridement due to wound infection postoperatively.(\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e) possibly related to mechanisms such as immune function suppression, inflammation regulation, muscle metabolism imbalance, and tissue repair disorders. Reduced muscle mass may affect protein metabolism and the secretion of anti-inflammatory factors such as IL-6 and IL-15, while also decreasing the inhibitory effect on pro-inflammatory factors(\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). The decline in muscle metabolic function cannot provide the necessary proteins and growth factors for wound repair, and the stress condition of surgery exacerbates the imbalance in muscle metabolism, ultimately leading to reduced postoperative infection resistance and delayed wound healing in sarcopenic patients(\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e), which can be validated by the higher incidence of debridement in these patients.\u003c/p\u003e \u003cp\u003eFurthermore, the increased need for blood transfusions in sarcopenic patients postoperatively may be related to sarcopenia-associated anemia(\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e), coagulation dysfunction(\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e), and the characteristic of increased intraoperative bleeding during sacral tumor resection. Our data show that patients in the sarcopenia group had significantly higher proportions of preoperative anemia and intraoperative massive hemorrhage (\u0026gt;\u0026thinsp;2000ml) than those in the control group. Moreover, the proportion of preoperative CFI\u0026thinsp;\u0026ge;\u0026thinsp;2 (manifested by low albumin levels, hematocrit, and BMI) was also higher in the sarcopenia group. This bleeding tendency may result from multiple pathophysiological mechanisms. Chronic inflammation associated with sarcopenia can exacerbate anemia by upregulating hepcidin levels through IL-6-mediated inhibition of erythropoiesis, while low albumin impairs platelet aggregation by reducing thromboxane A2 synthesis.(\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e)Frail may contribute to an increased risk of major bleeding by reducing cardiovascular stress tolerance, impairing the balance between angiogenesis and repair, delaying vessel closure due to dysregulation, and compromising liver synthesis of coagulation factors (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e). Ultimately, it leads to an increase in the demand for blood transfusion among patients with sarcopenia after surgery.\u003c/p\u003e \u003cp\u003eThis study found that the related factors of sarcopenia include older age, low BMI, low L3 SMI, malignant tumors, preoperative chemotherapy, and lower levels of hemoglobin and albumin, indicating a multifactorial pathogenesis of sarcopenia in the surgical population (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e).Age is a physiological factor in the occurrence of sarcopenia, and this study found that the incidence of sarcopenia is higher in the elderly population aged\u0026thinsp;\u0026ge;\u0026thinsp;60 years(\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e). Additionally, low muscle mass, such as low BMI and low waist muscle area, reflects a decrease in body function, which can affect the intake and utilization of nutrients(\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e), leading to the occurrence of sarcopenia. Some studies have found that chemotherapy in patients with malignant tumors increases the incidence of sarcopenia(\u003cspan additionalcitationids=\"CR38 CR39\" citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e), which is consistent with the conclusions of this study. Furthermore, this study further confirmed that the key biomarkers of sarcopenia, hemoglobin and albumin, are negatively correlated with sarcopenia (\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e).\u003c/p\u003e \u003cp\u003ePatients in the Sarcopenia group had a significantly lower CFI, including low BMI, hypoproteinemia, anemia, abnormal renal function. These indicators are all related to postoperative wound infection, delayed healing and pulmonary complications. A low BMI may manifest as a decline in the body's functions, reduced intake and utilization of nutrients, resulting in a decreased ability of the body to cope with surgical stress, thereby increasing the risks of postoperative infection and delayed wound healing, and raising the risk of postoperative debridement (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e). Low protein, anemia and abnormal blood creatinine levels can trigger chronic inflammatory responses and affect postoperative recovery(\u003cspan additionalcitationids=\"CR44\" citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e). In the analysis of risk factors for Clavien-Dindo classification grades\u0026thinsp;\u0026ge;\u0026thinsp;2, it was found that sarcopenia has an independent association with these complications, increasing the risk of postoperative complications by nearly twofold. This further confirms previous evidence that muscle wasting impairs the body's overall resistance to surgical stress, and insufficient muscle mass is directly related to poor postoperative outcomes. In the analysis of the relationship between sarcopenia, frailty index, and Clavien-Dindo classification grades\u0026thinsp;\u0026ge;\u0026thinsp;2, it was found that the proportion of patients with preoperative CFI\u0026thinsp;\u0026ge;\u0026thinsp;2 in the sarcopenia group was significantly higher than that in the control group, suggesting a significant synergy between sarcopenia and frailty status in perioperative patients. Clinically, muscle assessment should be regarded as a core component of frailty management(\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eRegarding intraoperative hemodynamic instability factors, we first conducted a mediation effect analysis, and the results were consistent with our expectations, indicating that hemodynamic instability plays a partial mediating role in the incidence of Clavien-Dindo classification grades\u0026thinsp;\u0026ge;\u0026thinsp;2 in patients with sarcopenia. Secondly, in the multifactorial analysis of Clavien-Dindo classification grades\u0026thinsp;\u0026ge;\u0026thinsp;2, FCM\u0026thinsp;\u0026gt;\u0026thinsp;15% was identified as an independent predictive factor. ROC curve analysis of sarcopenia and FCM\u0026thinsp;\u0026gt;\u0026thinsp;15% revealed that their combination could enhance the predictive ability for Clavien-Dindo classification grades\u0026thinsp;\u0026ge;\u0026thinsp;2. In patients undergoing sacral tumor surgery, those with sarcopenia have a significantly increased proportion of intraoperative massive bleeding(\u0026gt;2000ml), leading to a higher incidence of hemodynamic instability caused by massive bleeding, which affects intraoperative blood pressure and cardiac output, ultimately resulting in inadequate perfusion of vital organs and increasing the risk of postoperative complications. Therefore, implementing effective hemodynamic monitoring and management strategies is one of the key factors to ensure surgical success. Appropriate fluid resuscitation can effectively improve the hemodynamic status of patients and reduce the occurrence of intraoperative hypotension; however, excessive fluid input may lead to increased cardiac burden and a higher risk of postoperative pulmonary complications(\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e).. Thus, developing an individualized fluid management plan and dynamically adjusting it based on the patient's specific condition is a necessary measure to achieve favorable postoperative outcomes.\u003c/p\u003e \u003cp\u003eAlthough this study provides data related to postoperative complications of sacral tumors, there are also some limitations. First, the retrospective nature of the study limits the data we can collect. Additionally, it remains unknown whether sacral tumors lead to changes in skeletal muscle area at the L3 level, which requires further studies to confirm. This study may be criticized for its retrospective design and the outcomes assessed during the hospital stay. Furthermore, the study did not collect follow-up information to investigate the patients' conditions after discharge, which presents certain shortcomings.\u003c/p\u003e \u003cp\u003eEarly identification and intervention measures for sarcopenia will be key to improving postoperative prognosis in patients with sacral tumors. Future research could focus on the following aspects: first, prospective experiments are needed to verify the expression of sarcopenia in a larger clinical sample and its relationship with the prognosis of patients with sacral tumors; second, exploring the specific mechanisms of sarcopenia in the postoperative recovery of sacral tumor patients, particularly its interactions with other clinical factors; finally, developing intervention strategies targeting sarcopenia and validating their effectiveness in clinical practice. These studies will help to comprehensively understand the role of sarcopenia in sacral tumor patients and provide new strategies for improving postoperative management.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eOverall, in this retrospective cohort study on postoperative complications in patients undergoing sacral tumor surgery, sarcopenia was found to be associated with a higher incidence and severity of surgical complications in patients who underwent sacrectomy and received IABO, and it is an independent risk factor for Clavien-Dindo classification grades\u0026thinsp;\u0026ge;\u0026thinsp;2. Intraoperative hemodynamic instability plays a mediating role between sarcopenia and Clavien-Dindo classification grades\u0026thinsp;\u0026ge;\u0026thinsp;2.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAbbreviation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 387px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFull Term\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAIMS\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 387px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAnesthesia information management system\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eASA\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 387px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAmerican society of Aneshesiologists\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAUC\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 387px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eArea Under Curve\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBMI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 387px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBody mass index\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCFI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 387px;\"\u003e\n \u003cp\u003e\u003cstrong\u003echart-derived frailty index\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCRC\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 387px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eConcentrated red bloodcells\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCT\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 387px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eComputed Tomography\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFFP\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 387px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFresh frozen plasma\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFCM\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 387px;\"\u003e\n \u003cp\u003e\u003cstrong\u003efractional change in mean arterial pressure\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIABO\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 387px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eintra-aortic balloon occlusion\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eICU\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 387px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIntensive Care Unit\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIQR\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 387px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eInterquartile spacing\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMAP\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 387px;\"\u003e\n \u003cp\u003e\u003cstrong\u003emean arterial pressure\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSMI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 387px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eskeletal muscle mass index\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e：The study protocol was approved by the Ethics Committee of Peking University People\u0026rsquo;s Hospital, Beijing, China, which waived the requirement for informed consent because of the retrospective design. This article complied with the STROBE guidelines for a retrospective study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to Participate declaration: \u003c/strong\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number: \u003c/strong\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication：\u003c/strong\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials:\u003c/strong\u003e All data generated or analysed during this study are included in this published article [and its supplementary information files].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests: \u003c/strong\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e\u0026nbsp;Beijing Municipal Natural Science Foundation (grant No. M22010).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions:\u003c/strong\u003e\u0026nbsp;JXZ conceptualized the study, designed the methodology, performed data analysis, and wrote the original draft. HZ supervised the project, acquired funding, reviewed and edited the manuscript, and approved the final version for submission. BA contributed to data curation, validation, and formal analysis. YF provided clinical expertise, interpreted results, and critically revised the manuscript for intellectual content. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u003c/strong\u003e Not applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eHuang L, Guo W, Yang R, Tang X, Ji T. Proposed Scoring System for Evaluating Neurologic Deficit after Sacral Resection: Functional Outcomes of 170 Consecutive Patients. Spine (Phila Pa 1976). 2016;41(7):628-37. doi:10.1097/BRS.0000000000001274.\u003c/li\u003e\n\u003cli\u003eTang X, Guo W, Yang R, Tang S, Dong S. Use of aortic balloon occlusion to decrease blood loss during sacral tumor resection. J Bone Joint Surg Am. 2010;92(8):1747-53. doi:10.2106/jbjs.I.01333.\u003c/li\u003e\n\u003cli\u003e李琪, 赵红, 燕太强. 腹主动脉内球囊阻断技术用于骨盆和骶骨肿瘤切除术的研究进展. 临床麻醉学杂志. 2022;38(5):549-52. doi:10.12089/jca.2022.05.020.\u003c/li\u003e\n\u003cli\u003e唐顺, 董森, 郭卫, 杨荣利. 腹主动脉球囊阻断控制骶骨肿瘤切除术中出血的效果. 中国脊柱脊髓杂志. 2009;19(2):85-9. doi:10.3969/j.issn.1004-406X.2009.02.01.\u003c/li\u003e\n\u003cli\u003eChen LK, Liu LK, Woo J, Assantachai P, Auyeung TW, Bahyah KS, et al. Sarcopenia in Asia: consensus report of the Asian Working Group for Sarcopenia. J Am Med Dir Assoc. 2014;15(2):95-101. doi:10.1016/j.jamda.2013.11.025.\u003c/li\u003e\n\u003cli\u003eWang J, Chen Y, He J, Yin C, Xie M. Sarcopenia Predicts Postoperative Complications and Survival of Colorectal Cancer Patients Undergoing Radical Surgery. Br J Hosp Med (Lond). 2024;85(9):1-17. doi:10.12968/hmed.2024.0297.\u003c/li\u003e\n\u003cli\u003eNagarajan G, Doshi P, Bardeskar NS, Kulkarni A, Punamiya A, Tongaonkar H. Association between sarcopenia and postoperative complications in patients undergoing surgery for gastrointestinal or hepato-pancreatico-biliary cancer. J Surg Oncol. 2023;128(4):682-91. doi:10.1002/jso.27315.\u003c/li\u003e\n\u003cli\u003eChen WS, Huang YS, Xu LB, Shi MM, Chen XD, Ye GQ, et al. Effects of sarcopenia, hypoalbuminemia, and laparoscopic surgery on postoperative complications in elderly patients with colorectal cancer: A prospective study. Neoplasma. 2020;67(4):922-32. doi:10.4149/neo_2020_190908N882.\u003c/li\u003e\n\u003cli\u003eCoker RH, Wolfe RR. Bedrest and sarcopenia. Curr Opin Clin Nutr Metab Care. 2012;15(1):7-11. doi:10.1097/MCO.0b013e32834da629.\u003c/li\u003e\n\u003cli\u003eChen F, Adhami M, Tan M, Grodski S, Serpell J, Orr A, et al. Hypotension in Posterior Retroperitoneoscopic Versus Transperitoneal Laparoscopic Adrenalectomy. J Surg Res. 2022;275:87-95. doi:10.1016/j.jss.2022.01.013.\u003c/li\u003e\n\u003cli\u003ePolyzogopoulou E, Amoiridou P, Abraham TP, Ventoulis I. Acute liver injury in COVID-19 patients hospitalized in the intensive care unit: Narrative review. World J Gastroenterol. 2022;28(47):6662-88. doi:10.3748/wjg.v28.i47.6662.\u003c/li\u003e\n\u003cli\u003eJames LA, Levin MA, Lin HM, Deiner SG. Association of Preoperative Frailty With Intraoperative Hemodynamic Instability and Postoperative Mortality. Anesth Analg. 2019;128(6):1279-85. doi:10.1213/ane.0000000000004085.\u003c/li\u003e\n\u003cli\u003eBailey AJ, Lee A, Li HO, Glen P. Intraoperative balloon occlusion of the aorta for blood management in sacral and pelvic tumor resection: A systematic review and meta-analysis. Surg Oncol. 2020;35:156-61. doi:10.1016/j.suronc.2020.08.016.\u003c/li\u003e\n\u003cli\u003eIrahara T, Sato N, Moroe Y, Fukuda R, Iwai Y, Unemoto K. Retrospective study of the effectiveness of Intra-Aortic Balloon Occlusion (IABO) for traumatic haemorrhagic shock. World J Emerg Surg. 2015;10(1):1. doi:10.1186/1749-7922-10-1.\u003c/li\u003e\n\u003cli\u003eAmrock LG, Neuman MD, Lin HM, Deiner S. Can routine preoperative data predict adverse outcomes in the elderly? Development and validation of a simple risk model incorporating a chart-derived frailty score. J Am Coll Surg. 2014;219(4):684-94. doi:10.1016/j.jamcollsurg.2014.04.018.\u003c/li\u003e\n\u003cli\u003eMurray T, Williams D, Lee MJ. Erratum to: Osteoporosis, obesity, and sarcopenia on abdominal CT: a review of epidemiology, diagnostic criteria, and management strategies for the reporting radiologist. Abdom Radiol (NY). 2018;43(5):1281. doi:10.1007/s00261-017-1274-5.\u003c/li\u003e\n\u003cli\u003eHamaguchi Y, Kaido T, Okumura S, Kobayashi A, Shirai H, Yao S, et al. Proposal for new selection criteria considering pre-transplant muscularity and visceral adiposity in living donor liver transplantation. J Cachexia Sarcopenia Muscle. 2018;9(2):246-54. doi:10.1002/jcsm.12276.\u003c/li\u003e\n\u003cli\u003eTang X, Guo W, Yang R, Tang S, Ji T. Risk factors for blood loss during sacral tumor resection. Clin Orthop Relat Res. 2009;467(6):1599-604. doi:10.1007/s11999-008-0483-1.\u003c/li\u003e\n\u003cli\u003eNarayan M, Medinilla SP. Fever in the postoperative patient. Emerg Med Clin North Am. 2013;31(4):1045-58. doi:10.1016/j.emc.2013.07.011.\u003c/li\u003e\n\u003cli\u003e张芳芳, 胡雅静, 黄华勇, 倪锦晖, 尤泽, 常巧玲, et al. 基于CT诊断的肌少症对结直肠癌患者发生手术部位感染的影响因素分析. 中国全科医学. 2022;25(29):3658-63. doi:10.12114/j.issn.1007-9572.2022.0429.\u003c/li\u003e\n\u003cli\u003eYang J, Zhang T, Feng D, Dai X, Lv T, Wang X, et al. A new diagnostic index for sarcopenia and its association with short-term postoperative complications in patients undergoing surgery for colorectal cancer. Colorectal Dis. 2019;21(5):538-47. doi:10.1111/codi.14558.\u003c/li\u003e\n\u003cli\u003eSilva de Paula N, de Aguiar Bruno K, Azevedo Aredes M, Villa\u0026ccedil;a Chaves G. Sarcopenia and Skeletal Muscle Quality as Predictors of Postoperative Complication and Early Mortality in Gynecologic Cancer. Int J Gynecol Cancer. 2018;28(2):412-20. doi:10.1097/igc.0000000000001157.\u003c/li\u003e\n\u003cli\u003eZakaria HM, Schultz L, Mossa-Basha F, Griffith B, Chang V. Morphometrics as a predictor of perioperative morbidity after lumbar spine surgery. Neurosurg Focus. 2015;39(4):E5. doi:10.3171/2015.7.Focus15257.\u003c/li\u003e\n\u003cli\u003ePetersen AM, Pedersen BK. The anti-inflammatory effect of exercise. J Appl Physiol (1985). 2005;98(4):1154-62. doi:10.1152/japplphysiol.00164.2004.\u003c/li\u003e\n\u003cli\u003eScheffer DDL, Latini A. Exercise-induced immune system response: Anti-inflammatory status on peripheral and central organs. Biochim Biophys Acta Mol Basis Dis. 2020;1866(10):165823. doi:10.1016/j.bbadis.2020.165823.\u003c/li\u003e\n\u003cli\u003eLieffers JR, Bathe OF, Fassbender K, Winget M, Baracos VE. Sarcopenia is associated with postoperative infection and delayed recovery from colorectal cancer resection surgery. Br J Cancer. 2012;107(6):931-6. doi:10.1038/bjc.2012.350.\u003c/li\u003e\n\u003cli\u003eOlmez T, Gulmez S, Karakose E, Ofluoglu CB, Senger AS, Bozkurt H, et al. Relation between Sarcopenia and Surgical Site Infection in Patients Undergoing Gastric Cancer Surgery. Surg Infect (Larchmt). 2021;22(5):551-5. doi:10.1089/sur.2020.211.\u003c/li\u003e\n\u003cli\u003eLee DY, Shin S. Sarcopenia and Anemia in Elderly Koreans: A Nationwide Population-Based Study. Healthcare (Basel). 2023;11(17). doi:10.3390/healthcare11172428.\u003c/li\u003e\n\u003cli\u003eLevi M, van der Poll T. Inflammation and coagulation. Crit Care Med. 2010;38(2 Suppl):S26-34. doi:10.1097/CCM.0b013e3181c98d21.\u003c/li\u003e\n\u003cli\u003eConde D\u0026iacute;ez S, de Las Cuevas Allende R, Conde Garc\u0026iacute;a E. Anemia of inflammation and iron metabolism in chronic diseases. Rev Clin Esp (Barc). 2024;224(9):598-608. doi:10.1016/j.rceng.2024.09.002.\u003c/li\u003e\n\u003cli\u003eHe L, He R, Huang J, Zou C, Fan Y. Impact of frailty on all-cause mortality and major bleeding in patients with atrial fibrillation: A meta-analysis. Ageing Res Rev. 2022;73:101527. doi:10.1016/j.arr.2021.101527.\u003c/li\u003e\n\u003cli\u003eLaviano A. Sarcopenia, biological age and treatment eligibility in patients with cancer. Curr Opin Clin Nutr Metab Care. 2023;26(1):59-63. doi:10.1097/mco.0000000000000888.\u003c/li\u003e\n\u003cli\u003eTamura T, Sakurai K, Nambara M, Miki Y, Toyokawa T, Kubo N, et al. Adverse Effects of Preoperative Sarcopenia on Postoperative Complications of Patients With Gastric Cancer. Anticancer Res. 2019;39(2):987-92. doi:10.21873/anticanres.13203.\u003c/li\u003e\n\u003cli\u003e张建, 华琦. 中国老龄化的特征发展趋势与对策. 中国心血管杂志. 2010;15(1):79-80. doi:10.3969/j.issn.1007-5410.2010.01.029.\u003c/li\u003e\n\u003cli\u003eXu J, Zheng B, Zhang S, Zeng T, Chen H, Zheng W, et al. Effects of preoperative sarcopenia on postoperative complications of minimally invasive oesophagectomy for oesophageal squamous cell carcinoma. J Thorac Dis. 2019;11(6):2535-45. doi:10.21037/jtd.2019.05.55.\u003c/li\u003e\n\u003cli\u003eShi B, Liu S, Chen J, Liu J, Luo Y, Long L, et al. Sarcopenia is Associated with Perioperative Outcomes in Gastric Cancer Patients Undergoing Gastrectomy. Ann Nutr Metab. 2019;75(4):213-22. doi:10.1159/000504283.\u003c/li\u003e\n\u003cli\u003eRyan AM, Prado CM, Sullivan ES, Power DG, Daly LE. Effects of weight loss and sarcopenia on response to chemotherapy, quality of life, and survival. Nutrition. 2019;67-68:110539. doi:10.1016/j.nut.2019.06.020.\u003c/li\u003e\n\u003cli\u003evan Vugt JL, Braam HJ, van Oudheusden TR, Vestering A, Bollen TL, Wiezer MJ, et al. Erratum to: Skeletal Muscle Depletion is Associated with Severe Postoperative Complications in Patients Undergoing Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Carcinomatosis of Colorectal Cancer. Ann Surg Oncol. 2015;22 Suppl 3:S1610. doi:10.1245/s10434-015-4467-6.\u003c/li\u003e\n\u003cli\u003eAnandavadivelan P, Brismar TB, Nilsson M, Johar AM, Martin L. Sarcopenic obesity: A probable risk factor for dose limiting toxicity during neo-adjuvant chemotherapy in oesophageal cancer patients. Clin Nutr. 2016;35(3):724-30. doi:10.1016/j.clnu.2015.05.011.\u003c/li\u003e\n\u003cli\u003eBarret M, Antoun S, Dalban C, Malka D, Mansourbakht T, Zaanan A, et al. Sarcopenia is linked to treatment toxicity in patients with metastatic colorectal cancer. Nutr Cancer. 2014;66(4):583-9. doi:10.1080/01635581.2014.894103.\u003c/li\u003e\n\u003cli\u003eBenedek Z, Todor-Bo\u0026eacute;r S, Kocsis L, Bauer O, Suciu N, Coroș MF. Psoas Muscle Index Defined by Computer Tomography Predicts the Presence of Postoperative Complications in Colorectal Cancer Surgery. Medicina (Kaunas). 2021;57(5). doi:10.3390/medicina57050472.\u003c/li\u003e\n\u003cli\u003ePicca A, Coelho-Junior HJ, Calvani R, Marzetti E, Vetrano DL. Biomarkers shared by frailty and sarcopenia in older adults: A systematic review and meta-analysis. Ageing Res Rev. 2022;73:101530. doi:10.1016/j.arr.2021.101530.\u003c/li\u003e\n\u003cli\u003eHarris AB, Badin D, Hegde V, Oni JK, Sterling RS, Khanuja HS. Preoperative Anemia is an Independent Risk Factor for Increased Complications and Mortalities After Total Knee Arthroplasty Regardless of Postoperative Transfusions. J Arthroplasty. 2023;38(7 Suppl 2):S177-s81. doi:10.1016/j.arth.2023.01.042.\u003c/li\u003e\n\u003cli\u003eChen X, Shen Y, Hou L, Yang B, Dong B, Hao Q. Sarcopenia index based on serum creatinine and cystatin C predicts the risk of postoperative complications following hip fracture surgery in older adults. BMC Geriatr. 2021;21(1):541. doi:10.1186/s12877-021-02522-1.\u003c/li\u003e\n\u003cli\u003eHu Y, Wang L, Liu H, Yang K, Wang S, Zhang X, et al. Association of preoperative hypoprotein malnutrition with spinal postoperative complications and other conditions: A systematic review and meta-analysis. Clin Nutr ESPEN. 2023;57:448-58. doi:10.1016/j.clnesp.2023.07.083.\u003c/li\u003e\n\u003cli\u003eLi Q, Dong S, Yan T, Zhao H. Association between intraoperative fluid overload and postoperative debridement in major sacrum tumor resection: A propensity score matching study. Medicine (Baltimore). 2022;101(40):e30947. doi:10.1097/md.0000000000030947.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Footnotes","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003e Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. Demographic and Surgical Data\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTable 1. Demographic and Surgical Data\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"596\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 209px;\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003eSarcopenia Group\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;(n=96)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003eControl Group\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;(n=125)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003eStatistical value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003eP-Value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 209px;\"\u003e\n \u003cp\u003eL3 SMI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e30.99 (8.36)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e43.47 (11.12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e-10.098\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026lt;0.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 209px;\"\u003e\n \u003cp\u003eMale Gender (n(%))\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e53 (55.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e72 (57.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.126\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e0.722\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 209px;\"\u003e\n \u003cp\u003eAge (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e50 (30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e44 (24)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e-1.084\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e0.278\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 209px;\"\u003e\n \u003cp\u003eAge\u0026ge;60 (n(%))\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e25 (26%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e15 (12%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e7.222\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e0.007*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 209px;\"\u003e\n \u003cp\u003eBMI (km/cm\u0026sup2;)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e21.3 \u0026plusmn; 3.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e24.1 \u0026plusmn; 3.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e-6.623\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026lt;0.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 209px;\"\u003e\n \u003cp\u003eASA classification (n)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e1.192\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e0.551\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 209px;\"\u003e\n \u003cp\u003eI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e21 (21.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e30 (24%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 209px;\"\u003e\n \u003cp\u003eII\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e67 (69.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e89 (71.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 209px;\"\u003e\n \u003cp\u003eIII\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e8 (8.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e6 (4.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 209px;\"\u003e\n \u003cp\u003eHypertension (n(%))\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e7 (7.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e11(8.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.165\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0.684\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 209px;\"\u003e\n \u003cp\u003eDiabetes (n(%))\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e3 (3.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e2 (1.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.090\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0.765\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 209px;\"\u003e\n \u003cp\u003eCoronary artery disease (n(%))\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e/\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e/\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e/\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e/\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 209px;\"\u003e\n \u003cp\u003eRespiratory disease (n(%))\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e12 (12.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e15 (12%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.013\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0.910\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 209px;\"\u003e\n \u003cp\u003eDiagnosis (n(%))\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 209px;\"\u003e\n \u003cp\u003eBenign (n(%))\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e29 (30.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e57 (45.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e5.411\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e0.020*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 209px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Giant cell tumor (n)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 209px;\"\u003e\n \u003cp\u003eAneurysmal bone cyst (n)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 209px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Neurofibroma (n)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 209px;\"\u003e\n \u003cp\u003eSchwannoma (n)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 209px;\"\u003e\n \u003cp\u003eHemangioma (n)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 209px;\"\u003e\n \u003cp\u003eMyxoma (n)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 209px;\"\u003e\n \u003cp\u003eSolitary fibroadenoma (n)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 209px;\"\u003e\n \u003cp\u003eEpendymoma (n)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 209px;\"\u003e\n \u003cp\u003eDiagnosed as benign (n)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 209px;\"\u003e\n \u003cp\u003eMalignant (n(%))\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e53 (55.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e44 (35.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e8.827\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e0.003*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 209px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Chordoma (n)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 209px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Osteosarcoma (n)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 209px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Chondrosarcoma (n)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 209px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Ewing\u0026rsquo;s sarcoma (n)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 209px;\"\u003e\n \u003cp\u003eDiagnosed as malignant (n)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 209px;\"\u003e\n \u003cp\u003eMetastatic (n(%))\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e14 (14.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e24 (19.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.813\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e0.367\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 209px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Digestive tract tumor (n)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 209px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Urinary tract tumor (n)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 209px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Mammary carcinoma (n)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 209px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Thyroid tumor (n)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 209px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Liver cancer (n)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 209px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Lung cancer (n)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 209px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Cervical cancer (n)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 209px;\"\u003e\n \u003cp\u003ePEComa (n)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 209px;\"\u003e\n \u003cp\u003eAdipose tissue (n)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 209px;\"\u003e\n \u003cp\u003eBone tissue (n)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 209px;\"\u003e\n \u003cp\u003eRecurrent tumor (n(%))\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e15 (15.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e20 (16%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.006\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e0.940\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 209px;\"\u003e\n \u003cp\u003eSurgical approach\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 209px;\"\u003e\n \u003cp\u003eTotal En bloc (n(%))\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e13 (13.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e11 (8.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e1.261\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e0.261\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 209px;\"\u003e\n \u003cp\u003ePosterior (n(%))\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e69 ( 71.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e107 (85.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e6.308\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e0.012*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 209px;\"\u003e\n \u003cp\u003eAnterior and posterior\u003c/p\u003e\n \u003cp\u003e(n(%))\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e14 (14.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e7 (5.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e5.096\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e0.024*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 209px;\"\u003e\n \u003cp\u003eDuration of surgery (min)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e184 (78)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e177 (69)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e-1.656\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e0.098\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 209px;\"\u003e\n \u003cp\u003eDuration of anesthesia(min)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e270 (86)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e245 (81)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e-1.795\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e0.073\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 209px;\"\u003e\n \u003cp\u003eDuration of Aortic Occlusion (min)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e70 (46)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e67 (41)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e-0.729\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e0.466\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 209px;\"\u003e\n \u003cp\u003ePreoperative chemotherapy (n(%))\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e28 (29.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e22 (17.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e4.150\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e0.042*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 209px;\"\u003e\n \u003cp\u003eReoperation (n(%))\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e21 (21.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e24 (19.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.240\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e0.624\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 209px;\"\u003e\n \u003cp\u003ePreoperative analgesics (n(%))\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e52 (54.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e55 (44%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e2.247\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e0.134\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eData shown in mean \u0026plusmn; SD, median (IQR), n (%).\u003c/p\u003e\n\u003cp\u003eAbbreviations：IQR = interquartile range, SD = standard deviation , ASA=American Society of Anesthesiologists, BMI (Body mass index) = weight (in kg)/ height^2 (in m^2), SMI=skeletal muscle mass index ,calculated by normalizing skeletal muscle area at lumbar 3 level to the square of the patient\u0026rsquo;s height (cm^2/m^2) .\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e* P \u0026lt; 0.05.\u003c/p\u003e\n\u003cp\u003eTable 2. Anesthesia Management and Postoperative Outcomes\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"587\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003eSarcopenia Group\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;(n=96)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003eControl Group\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;(n=125)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003eStatistical value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003eP-Value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003eBlood Loss (mL)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e1175 (788)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e1000 (675)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e-1.618\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e0.106\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003eExtensive Blood Loss (\u0026gt;2000mL) (n(%))\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e16 (16.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e6 (4.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e8.530\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e0.006*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003eVolume of Infused CRC (mL)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e780 (520)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e520 (260)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e-1.796\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e0.072\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003eVolume of Infused FFP (mL)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e400 (550)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e400 (400)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e-2.164\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e0.030*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003eVolume of fluid infusion (mL)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e4680 (2300)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e4320 (1461)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e-2.219\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e0.026*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003eUrine Output (mL)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e825 (775)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e650 (625)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e-2.208\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e0.027*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003eFluid excess (mL/kg)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e45.2 (26.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e37.2 (19.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e-1.236\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e0.216\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003eFluid overload\u0026nbsp;(n(%))\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e63 (65.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e61 (48.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e6.242\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e0.012*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003ePreoperative hemoglobin (g/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e130 (24)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e137 (21)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e-3.356\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e0.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003ePostoperative hemoglobin (g/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e114 (24)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e118 (22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e-2.244\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e0.025*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003ePreoperative hematocrit (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e37.5 \u0026plusmn; 5.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e40.0 \u0026plusmn; 4.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e-3.640\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026lt;0.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003ePostoperative hematocrit (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e33.7 \u0026plusmn; 4.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e35.0 \u0026plusmn; 4.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e-2.080\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e0.039*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003ePreoperative albumin (g/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e40.2 (4.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e41.6 (4.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e-3.071\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e0.002*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003ePostoperative albumin (g/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e32.8 (4.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e34.1 (4.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e-2.722\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e0.006*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003ePreoperative blood creatinine (\u0026mu;moI/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e58 (21)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e65 (23)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e-3.390\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e0.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003ePostoperative blood creatinine (\u0026mu;moI/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e51(20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e59 (21)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e-3.425\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e0.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003ePreoperative hypoalbuminemia\u0026nbsp;(n(%))\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e5 (5.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e5 (4.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.184\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e0.668\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003ePostoperative hypoalbuminemia\u0026nbsp;(n(%))\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e71 (74%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e77 (61.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e3.749\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e0.054\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003ePreoperative anemia (n(%))\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e22 (22.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e12 (9.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e7.397\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e0.007*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003ePostoperative anemia (n(%))\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e49 (51%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e51 (40.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e2.299\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e0.129\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003eLength of Stay (days)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e21 (10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e20 (8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e-0.901\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e0.367\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003eProlonged hospital stay (n(%))\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e15 (15.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e13 (10.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e1.340\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e0.247\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003eVolume of drainage (ml)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e1930 (2006)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e1973 (1653)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e-0.106\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e0.915\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003ePreoperative CFI(n(%))\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e26.422\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026lt;0.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e49 (51%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e103(82.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e36(37.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e19(15.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e10(10.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e2(1.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e1(1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e1(0.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003ePreoperative CFI\u0026ge;2\u0026nbsp;(n(%))\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e11 (11.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e3 (2.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e7.509\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e0.006*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003ePostoperative CFI\u0026nbsp;(n(%))\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e22.861\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026lt;0.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e14(14.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e39(31.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e32(33.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e48(38.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e35(36.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e36(28.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e14(14.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e1(0.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e1(1.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e1(0.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003ePostoperative CFI\u0026ge;2\u0026nbsp;(n(%))\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e50 (52.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e38 (30.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e0.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eData shown in mean \u0026plusmn; SD, median (IQR), n (%).\u003c/p\u003e\n\u003cp\u003eAbbreviations：IQR = interquartile range, SD = standard deviation, CRC = concentrate red cell,\u0026nbsp;FFP = frozen fresh plasma, L3 SMI= Skeletal muscle area [(L3 muscle mass in c\u0026zwnj;m^2 )/ (height in m) ^2. CFI=chart-derived frailty index, The CFI is represented by the sum of five parameters , which includes age, preoperative body mass index (BMI), hematocrit, albumin, and serum creatinine,\u003c/p\u003e\n\u003cp\u003eFluid excess=Fluid infused (including CRC and FFP)-(Blood loss + Urine output)/Body weight, Fluid overload=fluid excess \u0026gt; 38.5 mL/kg, Prolonged hospital stay was defined as Hospital stay longer than 28 days, hypoalbuminemia was defined as albumin\u0026thinsp;\u0026lt;\u0026thinsp;30 g/L. Anemia was defined as adult male hemoglobin is less than 120g/L, and adult female hemoglobin is less than 110g/L.\u003c/p\u003e\n\u003cp\u003e* P\u0026lt;0.05\u003c/p\u003e\n\u003cp\u003eTable 3. Postoperative complication\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"587\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003eSarcopenia Group\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;(n=96)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003eControl Group\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;(n=125)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003eStatistical value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003eP-Value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003eClavien-Dindo classification grade 1(n(%))\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e35 (36.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e37 (29.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e1.163\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e0.281\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003eFever (n(%))\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e35 (36.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e37 (29.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e1.163\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e0.281\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003eClavien-Dindo classification grade 2(n(%))\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e29 (30.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e21 (16.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e5.576\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e0.018*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003ePostoperative blood transfusion (n(%))\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e27 (28.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e21 (16.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e4.096\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e0.043*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003ePulmonary complications grade 2 (n)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e2（2.1%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e0（0）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e2.628\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e0.105\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003eClavien-Dindo classification grade 3(n(%))\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e18 (18.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e11 (8.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e4.715\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e0.030*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003eDebridement (n(%))\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e9 (9.4%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e3 (2.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e5.144\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e0.023*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003eCerebrospinal fluid leak (n(%))\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e2 (2.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e4 (3.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.256\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e0.613\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003ePulmonary complications grade 3 (n)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e9（9.4%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e4（3.2%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e3.740\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e0.053\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003eClavien-Dindo classification grade 4 (n(%))\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e8 (8.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e3 (2.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e4.042\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e0.044*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003eICU admittance (n (%))\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e7 (7.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e3 (2.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e3.007\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e0.083\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003ePulmonary complications grade 4 (n)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e1（1%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e2（1.6%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.126\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e0.772\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003eClavien-Dindo classification grades \u0026ge;2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e41(42.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e32(25.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e7.185\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e0.007*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eData shown in mean \u0026plusmn; SD, median (IQR), n (%).\u003c/p\u003e\n\u003cp\u003eAbbreviations: IQR = interquartile range, SD = standard deviation, ICU = intensive care unit;\u003c/p\u003e\n\u003cp\u003ePostoperative fever was defined as postoperative temperature\u0026ge;38\u0026deg;C;\u003c/p\u003e\n\u003cp\u003eClavien-Dindo classification grade1:Postoperative fever;\u003c/p\u003e\n\u003cp\u003eClavien-Dindo classification grade2:Postoperative blood transfusion, pulmonary complications grade \u0026nbsp;grade 2 ;\u003c/p\u003e\n\u003cp\u003eClavien-Dindo classification grade3:Postoperative debridement, cerebrospinal fluid leakage, and pulmonary complications grade 3；\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eClavien-Dindo classification grade 4:postoperative admission to ICU,pulmonary complications grade 4.\u003c/p\u003e\n\u003cp\u003e* P\u0026lt;0.05\u003c/p\u003e\n\u003cp\u003eTable 4. Univariate analysis of Clavien-Dindo classification grades \u0026ge; 2\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"587\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003eComplication Group\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;(n=73)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 117px;\"\u003e\n \u003cp\u003eControl Group\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;(n=148)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003eStatistical value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003eP-Value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003eAge (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e48（24）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e44（25）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e-0.824\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e0.410\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003eAge\u0026ge;60 (n(%))\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e16（21.9%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e24（16.2%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e1.072\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e0.300\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003eASA classification (n)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.115\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e0.944\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003eI\u0026nbsp;(n(%))\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e16（21.9%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e35（23.6%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003eII\u0026nbsp;(n(%))\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e52（71.2%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e104（70.3%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003eIII\u0026nbsp;(n(%))\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e5（6.8%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e9（6.1%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003eBMI (km/cm\u0026sup2;)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e22.5 \u0026plusmn; 3.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e23.1 \u0026plusmn; 3.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e3.215\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e0.257\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003eBlood Loss (mL)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e1000（700）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e1000（788）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e-0.774\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e0.439\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003eFluid overload\u0026nbsp;(n(%))\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e43（58.9%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e81（54.7%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.346\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e0.556\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003eDuration of surgery (min)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e180（81）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e179（74）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e-0.398\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e0.691\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003eDuration of anesthesia (min)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e254（95）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e254（78）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e-0.507\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e0.612\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003ePreoperative anemia (n(%))\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e15（20.5%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e19（12.8%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e2.232\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e0.135\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003ePreoperative albumin (g/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e40.2（4.5）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e41.5（4.6）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e0.056\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003ePreoperative hypoalbuminemia\u0026nbsp;(n(%))\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e6（8.2%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e4（2.7%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e3.444\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e0.063\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003ePreoperative CFI(n(%))\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e6.486\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e0.090\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e43（58.9%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e109（73.6%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e22（30.1%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e33（22.3%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e7（9.6%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e5（3.4%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e1（1.4%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e1（0.7%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003eReoperation (n(%))\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e17（23.3%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e28（18.9%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.575\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e0.448\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003ePreoperative chemotherapy (n(%))\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e17（23.3%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e33（22.3%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.027\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e0.869\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003eSarcopenia (n(%))\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e41（56.2%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e55（37.2%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e7.185\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e0.007*\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp\u003eFCM\u0026gt;15%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e5（5）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e3（3）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e-3.210\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e0.001*\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eData shown in mean \u0026plusmn; SD, median (IQR), n (%).\u003c/p\u003e\n\u003cp\u003eAbbreviations: IQR = interquartile range, SD = standard deviation, FCM=fractional change in mean arterial pressure, CFI=chart-derived frailty index, The CFI is represented by the sum of five parameters , which includes age, preoperative body mass index (BMI), hematocrit, albumin, and serum creatinine.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFluid excess=Fluid infused (including CRC and FFP)-(Blood loss + Urine output)/Body weight, Fluid overload=fluid excess \u0026gt; 38.5 mL/kg, Hypoalbuminemia was defined as albumin\u0026thinsp;\u0026lt;\u0026thinsp;30 g/L. Anemia was defined as adult male hemoglobin is less than 120g/L, and adult female hemoglobin is less than 110g/L.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e* P\u0026lt;0.05\u003c/p\u003e\n\u003cp\u003eTable 5. Mediation effect analysis\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003eClavien-Dindo classification grades \u0026ge; 2\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003eFCM＞15%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003eClavien-Dindo classification grades \u0026ge; 2\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003eConstant\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e0.256**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e0.568**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e0.123*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003eSarcopenia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e0.171**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e0.953*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e0.136*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003eFCM＞15%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e0.037**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003eR\u0026sup2;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e0.033\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e0.027\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e0.082\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003eAdjustment R\u0026sup2;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e0.028\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e0.023\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e0.072\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003eF-value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e1.219**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e1.219**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e2.218**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eAbbreviations：FCM= fractional change in mean arterial pressure\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003eModel effect\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003eEffect size\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003eBoot\u003c/p\u003e\n \u003cp\u003eSE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 177px;\"\u003e\n \u003cp\u003eBootstrap95%CI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 172px;\"\u003e\n \u003cp\u003eEffect proportion\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003eTotal effect\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.171\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e0.063\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 177px;\"\u003e\n \u003cp\u003e0.047-0.295\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 172px;\"\u003e\n \u003cp\u003e100.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003eDirect effect\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.136\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e0.062\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 177px;\"\u003e\n \u003cp\u003e0.013-0.258\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 172px;\"\u003e\n \u003cp\u003e20.757%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003eTotal indirect effect\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.036\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e0.021\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 177px;\"\u003e\n \u003cp\u003e0.005-0.085\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 172px;\"\u003e\n \u003cp\u003e79.243%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eAbbreviations：95% CI=95% confidence interval\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-anesthesiology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bane","sideBox":"Learn more about [BMC Anesthesiology](http://bmcanesthesiol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bane","title":"BMC Anesthesiology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"sacrum tumor, sarcopenia, intra-aortic balloon occlusion, clinical outcome","lastPublishedDoi":"10.21203/rs.3.rs-6595292/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6595292/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eSacrum 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.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eThis 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.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e 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).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions: \u003c/strong\u003eSarcopenia 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.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number and registry URL: \u003c/strong\u003eNot applicable.\u003c/p\u003e","manuscriptTitle":"Effect of sarcopenia in patients undergoing sacrum tumor resection with intra-aortic balloon occlusion: a retrospective cohort study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-06-18 08:50:38","doi":"10.21203/rs.3.rs-6595292/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewersInvited","content":"","date":"2025-06-13T15:41:18+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-05-20T13:18:12+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-05-17T05:07:34+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-05-17T05:07:23+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Anesthesiology","date":"2025-05-05T14:21:38+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-anesthesiology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bane","sideBox":"Learn more about [BMC Anesthesiology](http://bmcanesthesiol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bane","title":"BMC Anesthesiology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"f5da0a65-9295-47d0-ab1b-a5679b33c959","owner":[],"postedDate":"June 18th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-06-18T08:50:39+00:00","versionOfRecord":[],"versionCreatedAt":"2025-06-18 08:50:38","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6595292","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6595292","identity":"rs-6595292","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}