Sarcopenia as a Risk Factor in Anesthesia: Impact on Perioperative Morbidity and Mortality

Sarcopenia is a progressive condition characterized by the loss of skeletal muscle mass, strength, and function, representing a critical risk factor in anesthesia and perioperative outcomes, particularly among older adults. Its pathophysiology involves complex cellular and metabolic mechanisms, including mitochondrial dysfunction, insulin resistance, chronic inflammation, oxidative stress, and hormonal imbalance, all of which contribute to impaired muscle regeneration and increased protein degradation. Nutritional deficiencies, especially low protein and vitamin D intake, further accelerate muscle deterioration and functional decline.
The prevalence of sarcopenia among surgical patients ranges from thirty to seventy-four percent, varying by age, sex, and diagnostic criteria. Accurate identification requires the combined evaluation of muscle mass, strength, and physical performance through techniques such as computed tomography, dual-energy X-ray absorptiometry, bioelectrical impedance, handgrip strength testing, and gait speed analysis. In the anesthetic context, reduced muscle mass and altered body composition modify drug distribution and clearance, increasing the risk of overdose, prolonged recovery, and postoperative delirium. Sarcopenic patients also have diminished cardiopulmonary reserve and thermoregulatory capacity, heightening their susceptibility to intraoperative instability and postoperative complications.
Sarcopenia independently predicts increased postoperative morbidity, mortality, prolonged mechanical ventilation, and extended hospital stays. Comprehensive management requires early screening, nutritional optimization, and prehabilitation programs combining resistance and aerobic exercise. During surgery, individualized anesthetic dosing and multimodal analgesia improve safety, while early mobilization and physiotherapy enhance recovery. Multidisciplinary collaboration among anesthesiologists, surgeons, nutritionists, and physiotherapists is essential to minimize complications, support functional rehabilitation, and improve survival and quality of life in patients affected by sarcopenia.