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Original article
Sarcopenia measured by tomography as a predictor of morbidity and mortality in thoracic surgery, a retrospective cohort study
Sarcopenia medida por tomografía como predictor de morbimortalidad en cirugía torácica, una cohorte retrospectiva
V. Martínez Hurtadoa,
Corresponding author
valeria.martinez@udea.edu.co

Corresponding author.
, C.D. Ramírez Lujána, C.A. Pardo Peñab, F.D. Casas Arroyavec, A. Garcíad
a Sección de Anestesiología y Reanimación, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia
b Departamento de Radiología, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia
c Sección de Anestesiología y Reanimación, Facultad de Medicina, Universidad de Antioquia; Hospital San Vicente Fundación, Medellín, Colombia
d Sección de Anestesiología y Reanimación, Facultad de Medicina, Universidad de Antioquia; Hospital Alma Máter de Antioquia; Hospital Pablo Tobón Uribe, Medellín, Colombia
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          "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Area under the curve of the discriminative capacity of height-adjusted muscle area for 30-day mortality&#46;</p> <p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">95&#37; CI&#44; 95&#37; confidence interval&#59; AUC&#44; area under the curve&#59; Ha-PM&#44; height-adjusted area of pectoral muscles&#59; Ha-ESM&#44; height-adjusted area of erector spinae muscles&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">The number and variety of therapeutic procedures performed in thoracic surgery has increased in recent years&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Post-procedural complications are associated with a significant increase in morbidity and mortality&#46; Approximately 20&#37; of patients undergoing lung resection present one or more postoperative complications&#44; up to 2&#37; of which are fatal&#46; The overall frequency of in-hospital deaths following pneumonectomy is 5&#37;&#44; following lobectomy 2&#37;&#44; and following esophagectomy 5&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Other significant clinical and economic impacts include prolonged hospital stay and need for intensive care&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Preoperative medical evaluations are performed to reduce perioperative morbidity and mortality and promote rapid functional recovery&#44;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> and this can only be achieved by predicting and managing the patient&#8217;s potential risks&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Various risk factors have been associated with complications in thoracis surgery&#44; including advanced age&#44; male sex&#44; smoking&#44; cancer&#44; anaemia&#44; chronic lung disease&#44; type of surgery&#44; and loss of muscle mass&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Sarcopenia is the progressive&#44; widespread loss of skeletal muscle mass and strength&#44; and is associated with physical disability&#44; poor quality of life&#44; increased mortality&#44; and poor outcomes in medical and surgical procedures&#44;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> such as postoperative complications and in-hospital mortality in the context of urgent surgery&#44; hepatocellular carcinoma&#44; and liver transplantation&#46;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#8211;10</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">One of the methods of diagnosing sarcopenia is tomographic measurement of different muscle areas&#44; particularly the pectoral and the erector spinae muscles&#46; Studies have shown an association between low pectoral and erector spinae muscle volume on tomography and worse outcomes in patients with cancer&#44; chronic obstructive pulmonary disease &#40;COPD&#41;&#44; and cystic fibrosis&#46;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#44;11&#8211;15</span></a> Small studies have also found a correlation between low muscle volume measured by tomography and perioperative morbidity and mortality in patients undergoing thoracic surgery&#46;<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">16&#44;17</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">In this study&#44; we evaluated the association between sarcopenia defined by measuring the pectoral and erector spinae muscles on chest tomography and perioperative morbidity and mortality in chest surgery&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Study design</span><p id="par0030" class="elsevierStylePara elsevierViewall">Retrospective cohort study approved by the ethics committee of the Hospital Universitario San Vicente Fundaci&#243;n &#40;HUSVF&#41; in the city of Medell&#237;n&#44; Colombia &#40;Decision 11-2021 of 23 April 2021&#41;&#46; Adult patients over 18 years of age undergoing scheduled open or video-assisted thoracic surgery between January 2010 and January 2020 who had had at least 1 chest CT scan prior to the surgical intervention were included&#46; Patients in whom the anthropometric data and outcomes of interest could not be obtained from the medical records were excluded&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">All anthropometric data were extracted from the patient&#8217;s electronic medical record&#58; American Society of Anesthesiology &#40;ASA&#41; class&#59; degree of cardiovascular risk and functional status&#59; comorbidities and toxic habits&#44; including smoking&#59; preoperative diagnosis&#59; and type of surgical intervention and approach&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Measurement of muscle volume</span><p id="par0040" class="elsevierStylePara elsevierViewall">The imaging studies that were routinely acquired by our hospital&#8217;s CT scanners &#40;Light Speed VCT &#91;GENERAL ELECTRIC&#174;&#93;&#44; CT INGENUITY 5000 PRO &#40;PHILIPS&#174;&#41;&#44; Optimal 520 &#91;GENERAL ELECTRIC&#174;&#93;&#41; were reviewed&#46; The area of the pectoral muscles was measured on a cross-sectional slice acquired at up to 1&#8239;cm from the sternoclavicular joint&#44; and the area of the erector spinae muscles was measured on a cross-sectional slice acquired at the level of the thoracic vertebra &#40;T12&#41;&#44; which was identified by counting the vertebra in a caudal direction &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; Finally&#44; the sum of the area of the 4 pectoral muscles was normalised for the patient&#39;s height&#44; and the variable was recorded as the height-adjusted area of the pectoral muscles &#40;Ha-PM&#41;&#46; After the same adjustment&#44; the height-adjusted area of the erector spinae muscles was recorded as &#40;Ha-ESM&#41;&#46; Both measurements were reported in cm<span class="elsevierStyleSup">2</span>&#47;m<span class="elsevierStyleSup">2</span>&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Outcomes</span><p id="par0045" class="elsevierStylePara elsevierViewall">The primary outcome measure was 30-day all-cause mortality&#46; The secondary outcome measures were admission to the ICU within 7 postoperative days&#44; length of ICU stay&#44; need for invasive mechanical ventilation in the immediate postoperative period and&#47;or within the first 7 postoperative days&#44; and postoperative pneumonia of any type within 7 postoperative days&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Bias</span><p id="par0050" class="elsevierStylePara elsevierViewall">To avoid selection bias&#44; all patients that underwent chest surgery and met the inclusion criteria were included&#44; regardless of whether they died in hospital or were discharged home&#46; Given the retrospective nature of the study&#44; there were no losses during follow-up&#46; We excluded patients referred to other hospitals to continue treatment because their status at discharge from those centres was unknown&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">To avoid measurement bias&#44; the areas of interest were measured by one of the authors who was blinded to the clinical outcomes of interest and the other study variables at the time of measurement&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Since the outcome and exposure variables were clearly defined and were considered powerful&#44; the risk of classification bias was low&#46; Confounding was initially managed by strictly reviewing patient eligibility criteria and by identifying and controlling all potentially confounding variables with logistic regression models&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Sample size</span><p id="par0065" class="elsevierStylePara elsevierViewall">We used non-probabilistic convenience sampling methods&#44; and assessed all consecutive patients who underwent chest surgery between 2010 and 2020 for eligibility&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Based on Miller et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> to determine a mean thoracic spine muscle area of 10&#46;6 &#40;2&#46;6&#41;&#8239;cm<span class="elsevierStyleSup">2</span>&#47;m<span class="elsevierStyleSup">2</span> in patients who die within 30 postoperative days and of 8&#46;5 &#40;0&#46;3&#41; cm<span class="elsevierStyleSup">2</span>&#47;m<span class="elsevierStyleSup">2</span> in patients who do not die within 30 postoperative days&#44; with an estimated 500 patients recruited over the study period and assuming a type 1 error of 0&#46;05&#44; the power of the study would be between 90&#37; and 100&#37;&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Statistical analysis</span><p id="par0075" class="elsevierStylePara elsevierViewall">The clinical and demographic characteristics of the patients are presented as mean and standard deviation in the case of normally distributed continuous variables according to the Shapiro Wilk test&#44; and as median and interquartile range &#40;IQR&#41; for non-normally distributed variables&#46; Categorical variables are presented as absolute number and relative frequency&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">The incidence of 30-day morbidity and mortality outcomes was estimated using the Jeffrey method&#46; The correlation between Ha-PM and Ha-ESM was evaluated using the Pearson coefficient&#44; since the normality assumption had been fulfilled&#46; The difference between means of the height-adjusted muscle areas and outcomes was determined using the Student&#8217;s <span class="elsevierStyleItalic">t</span>-test and its respective confidence interval and p value&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">The discriminative capacity of Ha-PM and Ha-ESM for mortality and morbidity outcomes was evaluated by receiver operating characteristic &#40;ROC&#41; curve analysis&#46; Following the recommendation of Magder and Fix&#44;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> the Youden index was used to determine a potential muscle area cut point in the area under the curve &#40;AUC&#41;&#44; The value with the highest Youden index was used as the cut point on the muscle area scale&#46; Once the cut points had been obtained&#44; a univariate analysis was performed to determine the correlation between Ha-PM and Ha-ESM and the mortality and morbidity outcome&#46; The results are presented as odds ratios &#40;OR&#41; with their respective 95&#37; confidence interval &#40;95&#37; CI&#41; and p value&#46; Finally&#44; the height-adjusted muscle area variables and potential confounding variables &#40;variables with a p value less than 0&#46;1 in the univariate analysis for the 30-day mortality outcome&#41; were entered into multivariate logistic regression model&#44; and the results are presented as odds ratios &#40;OR&#41; and their respective 95&#37; CI&#46; A p value of less than 0&#46;05 was considered statistically significant for all estimators&#46; Statistical analysis was performed on SPSS Version 29&#46;</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Results</span><p id="par0090" class="elsevierStylePara elsevierViewall">A total of 509 patients undergoing thoracic surgery between 2014 and 2020 met the study eligibility criteria&#46; The height of patients scheduled before 2014 was not recorded in their clinical history&#44; so they were excluded &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; The majority of patients were men&#44; with an average age of 55 years&#46; Half &#40;50&#37;&#41; of the patients had a body mass index between 20&#46;9 and 26&#46;9&#8239;kg&#47;m<span class="elsevierStyleSup">2</span>&#59; 8&#37; were underweight&#44; and 9&#46;8&#37; were obese&#46; Over 70&#37; of patients were classified as ASA&#8239;&#8805;&#8239;III&#46; The main comorbidity was high blood pressure&#44; followed by diabetes mellitus and chronic kidney disease&#46; In almost half of the patients&#44; surgery was indicated due to infection-related septated exudate or transudate pleural effusion&#44; followed by cancer&#46; Consequently&#44; the main surgical intervention was decortication and pleurectomy&#44; followed by segmentectomy and&#47;or lobectomy&#46; Almost 90&#37; of these interventions were performed by video thoracoscopy &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">Major complications occurred in 23&#46;8&#37; of patients&#59; 30-day mortality was 7&#46;3&#37;&#59; postoperative ICU admission was 25&#46;5&#37;&#59; need for invasive mechanical ventilation was 14&#46;9&#37;&#59; and new onset postoperative pneumonia was 14&#46;5&#37;&#46; The median length of stay in the ICU was 8 days &#40;95&#37; CI 3&#8211;20&#41;&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">In 4 patients it was not possible evaluate Ha-PM and Ha-ESM due to oedema or inflammation&#59; these patients were excluded from the analysis&#46; Data from all the remaining patients were complete&#46; A moderate positive correlation was found between Ha-PM and Ha-ESM &#40;Pearson coefficient 0&#46;64&#59; p&#8239;&#60;&#8239;0&#46;001&#41;&#46; A statistically significant difference was found between mean Ha-PM and Ha-ESM and 30-day mortality and postoperative pneumonia&#46; No difference was found between the other outcomes &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0105" class="elsevierStylePara elsevierViewall">The AUC of Ha-PM and Ha-ESM for mortality was 0&#46;68 &#40;95&#37; CI 0&#46;595&#8211;0&#46;768&#59; p&#8239;&#60;&#8239;0&#46;001&#41; and 0&#46;67 &#40;95&#37; CI 0&#46;60&#8211;0&#46;74&#59; p&#8239;&#60;&#8239;0&#46;001&#41;&#44; respectively&#46; Regarding postoperative pneumonia&#44; the AUC of Ha-PM and Ha-ESM was 0&#46;56 &#40;95&#37; CI 0&#46;49&#8211;0&#46;62&#59; p&#8239;&#61;&#8239;0&#46;09&#41; and 0&#46;59 &#40;95&#37; CI 0&#46;52&#8211;0&#46;66&#44; p&#8239;&#61;&#8239;0&#46;011&#41;&#44; respectively &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0110" class="elsevierStylePara elsevierViewall">The Youden analysis showed that Ha-PM &#60; 10&#8239;cm<span class="elsevierStyleSup">2</span>&#47;m<span class="elsevierStyleSup">2</span> and Ha-ESM &#60; 8&#46;5&#8239;cm<span class="elsevierStyleSup">2</span>&#47;m<span class="elsevierStyleSup">2</span> had acceptable discriminative capacity for 30-day mortality&#46; Ha-PM &#60; 10&#8239;cm<span class="elsevierStyleSup">2</span>&#47;m<span class="elsevierStyleSup">2</span> had an unadjusted OR for 30-day mortality of 2&#46;84 &#40;95&#37; CI 1&#46;36&#8211;5&#46;97&#41; and Ha-ESM &#60; 8&#46;5&#8239;cm<span class="elsevierStyleSup">2</span>&#47;m<span class="elsevierStyleSup">2</span> had an unadjusted OR for 30-day mortality of 2&#46;68 &#40;95&#37; CI 1&#46;29&#8211;5&#46;66&#41;&#46; We were also able to determine the correlation between muscle area and postoperative pneumonia &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0115" class="elsevierStylePara elsevierViewall">Some confounding factors were identified&#58; COPD&#44; coronary heart disease&#44; and ASA classification&#8239;&#62;&#8239;III&#46; When risk was adjusted for the different confounding factors using multivariate analysis&#44; Ha-PM &#60; 10&#8239;cm<span class="elsevierStyleSup">2</span>&#47;m<span class="elsevierStyleSup">2</span> had an OR of 2&#46;34 &#40;95&#37; CI&#58; 1&#46;03&#8211;5&#46;15&#41; for mortality and Ha-ESM &#60; 8&#46;5&#8239;cm<span class="elsevierStyleSup">2</span>&#47;m<span class="elsevierStyleSup">2</span> had an OR of 2&#46;22 &#40;95&#37; CI&#58; 1&#46;10&#8211;6&#46;04&#41; for the same outcome&#46; No association was found between these values and pneumonia within 7 postoperative days &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Discussion</span><p id="par0120" class="elsevierStylePara elsevierViewall">In this study&#44; we found that Ha-PM and Ha-ESM was significantly correlated with 30-day mortality and postoperative pneumonia in patients undergoing thoracic surgery&#44; but did not affect other outcomes&#44; such as need for postoperative mechanical ventilation and admission and stay in ICU&#46; Ha-PM &#60; 10&#8239;cm<span class="elsevierStyleSup">2</span>&#47;m<span class="elsevierStyleSup">2</span> and Ha-ESM &#60; 8&#46;5&#8239;cm<span class="elsevierStyleSup">2</span>&#47;m<span class="elsevierStyleSup">2</span> showed acceptable discrimination for 30-day mortality&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Our results are consistent with those reported by Yang Du et al&#46;&#44; who evaluated the association between sarcopenia &#40;determined by measuring the cross-sectional area of the erector spinae muscle at the level of the lumbar spine&#41; and mortality in elderly patients undergoing emergency surgery&#46; The authors reported that a low skeletal muscle index increased the risk of postoperative complications and in-hospital death&#44; but did not affect the duration of ICU stay&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> Evaluation of muscle mass at the lumbar level requires a lower CT scan than that routinely performed to evaluate thoracic pathology&#44; and these images may not be available at the time of preoperative evaluation&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Our findings are also similar to those reported by Miller et al&#46; in their study of 299 patients undergoing lobectomy&#46; Like our study&#44; Ha-PM and Ha-ESM were measured using tomography&#44; and the authors found an inversely proportional relationship between the area of the erector spinae muscles and 30-day mortality and hospital stay outcomes&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> In our study&#44; we found a good correlation between muscle area and the risk of 30-day mortality&#44; and we were also able to define an Ha-PM cut point of &#60; 10&#8239;cm<span class="elsevierStyleSup">2</span>&#47;m<span class="elsevierStyleSup">2</span> and an Ha-ESM cut point of &#60; 8&#46;5&#8239;cm<span class="elsevierStyleSup">2</span>&#47;m<span class="elsevierStyleSup">2</span>&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Other studies have focussed on outcomes in lung cancer patients undergoing lung resection&#44; and have showed that sarcopenia is associated with lower overall and cancer-specific postoperative survival&#46;<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">19&#44;20</span></a> Instead of limiting our cohort to cancer patients&#44; we included the entire spectrum of thoracic surgery patients&#44; and this extends the discriminatory potential of our finding to adverse outcomes in all patients scheduled for thoracic surgery&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Most studies that have used CT scanning to evaluate sarcopenia have measured the cross-sectional area of the muscle at the level of the lumbar spine&#44; which requires abdominal imaging&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> We&#44; however&#44; chose to measure sarcopenia using chest tomography&#44; since previous studies such as that of Nemec et al&#46; have shown that measurements taken at L3 and T12 correlate adequately with sarcopenia&#46; Using this approach&#44; sarcopenia can be diagnosed directly from the same chest scans indicated for the patient&#8217;s pathology&#44; thus avoiding additional radiation and cost&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a></p><p id="par0145" class="elsevierStylePara elsevierViewall">Thoracic surgery is highly complex&#44; and these patients are considered to have an intermediate to high risk for complications and mortality&#46; Several risk factors for thoracic surgery-related complications have been described&#44; including advanced age&#44; high ASA classification&#44; COPD&#44; sepsis&#44; emergency surgery&#44; and surgery lasting more than 2&#8239;h&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Some of these factors&#44; such as lung disease&#44; are independently associated with increased prevalence of sarcopenia&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a> The evidence that nutritional status and frailty are associated with an increase in complications<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> underscores the importance of identifying strategies that can predict perioperative outcomes&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Identifying risk factors for an unfavourable outcome during the pre-anaesthesia workup will improve patient information and benefit shared decision-making&#46; It can also help develop risk stratification models to predict complications&#44; plan perioperative treatment&#44; and optimise the patient&#8217;s status prior to surgery&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0155" class="elsevierStylePara elsevierViewall">In our study&#44; we took into account the pre-established risk factors for worse outcomes in thoracic surgery&#46; As expected&#44; we found that COPD&#44; coronary heart disease&#44; and ASA classification&#8239;&#62;&#8239;III were negatively associated with survival&#46; Despite this&#44; our measurements continued to behave as independent risk factors for mortality&#46; Early identification of sarcopenia on tomography could help select patients for multidisciplinary preoperative optimization programs &#40;nutritional rehabilitation&#44; exercise and medication&#41; that can impact postoperative outcomes&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a></p><p id="par0160" class="elsevierStylePara elsevierViewall">Frailty is an important predictor of poor perioperative outcomes&#44; and is found in 12&#37; of thoracic surgery patients&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a> Sarcopenia is part of the frailty syndrome&#44; and these patients present loss of muscle mass and weakness&#46; In our retrospective cohort&#44; we were unable to determine whether sarcopenia assessed by Ha-PM and Ha-ESM is in itself a risk factor for increased mortality or whether the frailty syndrome <span class="elsevierStyleItalic">per se</span> is associated with that outcome&#46; This is one of the limitations of our study&#44; and further studies are needed to determine whether Ha-PM and Ha-ESM add discriminatory power to the assessment of frailty&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">Another limitation of our study is its single centre design&#44; which could limit the extrapolation of our data&#46; However&#44; since we included all surgical indications and procedures&#44; our cohort encompasses a wide spectrum of patients that is likely similar to that found in other hospitals&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">Finally&#44; a significant number of our patients underwent thoracoscopy procedures&#44; so our conclusions cannot be extrapolated to hospitals in which open surgery is more prevalent&#46; Additionally&#44; the muscle volume cut points for the risk of mortality established in our study need to be validated in another study and another population&#46; This will strengthen our results&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Conclusion</span><p id="par0175" class="elsevierStylePara elsevierViewall">In our cohort&#44; sarcopenia assessed by height-adjusted muscle area of the pectoralis and erector spinae muscles was an independent predictor of 30-day mortality in patients undergoing thoracic surgery&#46; Based on these results&#44; we believe that assessing these muscles on tomographic images could become one of the standard preoperative tests performed in these patients&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Funding</span><p id="par0180" class="elsevierStylePara elsevierViewall">The authors have not received specific funding from agencies in the private public and non-profit sectors&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Conflict of interest</span><p id="par0185" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflict of interest&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Presentation</span><p id="par0190" class="elsevierStylePara elsevierViewall">The results of this study were presented as an executive summary for consideration at the XXXV Colombian Congress of Anesthesiology and Resuscitation &#8211; 2023&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Sarcopenia has been identified as a risk factor for perioperative adverse events&#46; Several studies have shown that tomographic assessment of muscle mass can be an appropriate indicator of sarcopenia associated with morbidity and mortality&#46; The aim of the study was to determine the association between height-adjusted area of &#8203;&#8203;the pectoral and erector spinae muscles &#40;haPMA and haESA&#41; and perioperative morbidity and mortality in thoracic surgery&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Retrospective cohort study&#46; Measurement of muscle areas was performed by tomography&#46; The outcomes were 30-day mortality and postoperative morbidity&#46; The discriminative capacity of the muscle areas was evaluated with an analysis of ROC curves and the Youden index was used to establish a cut-off point&#46; The raw morbidity and mortality risk was determined and adjusted for potential confounders&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">A total of 509 patients taken to thoracic surgery were included&#46; The incidence of 30-day mortality was 7&#46;3&#37;&#46; An association was found between muscle areas and 30-day mortality and pneumonia&#44; with adequate discriminative power for mortality &#40;AUC 0&#46;68 for haPMA and 0&#46;67 for haESA&#41;&#46; An haPMA less than 10 and haESA less than 8&#46;5&#8239;cm<span class="elsevierStyleSup">2</span>&#47;m<span class="elsevierStyleSup">2</span> were identified as a risk factor for 30-day mortality with an adjusted OR of 2&#46;34 &#40;95&#37;CI 1&#46;03&#8211;5&#46;15&#41; and 2&#46;22 &#40;95&#37;CI 1&#46;10&#8211;6&#46;04&#41; respectively&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Sarcopenia&#44; defined as low muscle area in the pectoral and erector spinae muscles&#44; is associated with increased morbidity and mortality in patients undergoing thoracic surgery&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Antecedentes</span><p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">La sarcopenia se ha identificado como factor de riesgo para eventos adversos perioperatorios&#46; Varios estudios han demostrado que la valoraci&#243;n tomogr&#225;fica de la masa muscular puede ser un indicador apropiado de sarcopenia asociado a morbimortalidad&#46; El objetivo del estudio fue determinar la asociaci&#243;n entre el &#225;rea de los m&#250;sculos pectorales y erectores de la espina ajustados por talla &#40;AaMP y AaMEE&#41; y morbimortalidad perioperatoria en cirug&#237;a tor&#225;cica&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">Estudio de cohortes retrospectivo&#46; Se realiz&#243; medici&#243;n de &#225;reas musculares mediante tomograf&#237;a&#46; Los desenlaces fueron mortalidad a 30 d&#237;as y morbilidad posoperatoria&#46; Se evalu&#243; la capacidad discriminativa de las &#225;reas musculares con un an&#225;lisis de curvas ROC y se emple&#243; el &#237;ndice de Youden para establecer un punto de corte&#46; Se determin&#243; el riesgo de morbimortalidad crudo y ajustado por potenciales confusores&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">Se incluyeron 509 pacientes llevados a cirug&#237;a tor&#225;cica&#46; La incidencia de mortalidad a 30 d&#237;as fue del 7&#44;3&#37;&#46; Se encontr&#243; una asociaci&#243;n entre las &#225;reas musculares y mortalidad a 30 d&#237;as y neumon&#237;a&#44; con una capacidad discriminativa adecuada para mortalidad &#40;AUC 0&#44;68 para AaMP y 0&#44;67 para AaMEE&#41;&#46; Se identific&#243; un AaMP menor a 10 y AaMEE menor a 8&#44;5&#8239;cm<span class="elsevierStyleSup">2</span>&#47;m<span class="elsevierStyleSup">2</span> como factor de riesgo para mortalidad a 30 d&#237;as con un OR ajustado de 2&#44;34 &#40;IC95&#37; 1&#44;03&#8211;5&#44;15&#41; y 2&#44;22 &#40;IC95&#37; 1&#44;10&#8211;6&#44;04&#41;&#44; respectivamente&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0105" class="elsevierStyleSimplePara elsevierViewall">La sarcopenia&#44; definida como una baja &#225;rea muscular en los m&#250;sculos pectorales y erectores de la espina&#44; se asocia a mayor morbimortalidad en los pacientes sometidos a cirug&#237;a tor&#225;cica&#46;</p></span>"
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Comorbidities&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>High blood pressure&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">178 &#40;35&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Diabetes mellitus&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">82 &#40;16&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Chronic obstructive pulmonary disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">51 &#40;10&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Chronic kidney failure&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">60 &#40;11&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Coronary heart disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">32 &#40;6&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Atrial fibrillation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25 &#40;4&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Heart failure&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">44 &#40;8&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Cerebrovascular disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;1&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Human immunodeficiency virus&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15 &#40;2&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Tuberculosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">31 &#40;6&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ASA classification&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>I&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9 &#40;1&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>II&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">104 &#40;20&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>III&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">342 &#40;67&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>IV&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">54 &#40;10&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pre-surgical diagnosis&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Pleural effusion<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">249 &#40;48&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Cancer<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">90 &#40;17&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Lung mass under study&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22 &#40;4&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Chest trauma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">43 &#40;8&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Mediastinal pathology&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">33 &#40;6&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Tracheal pathology&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17 &#40;3&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Spontaneous pneumothorax&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">33 &#40;6&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Other&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22 &#40;4&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Procedure&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Decortication and&#47;or pleurectomy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">279 &#40;54&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Segmentectomy and&#47;or lobectomy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">124 &#40;24&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Mediastinoscopy and lymph node dissection&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">59 &#40;11&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Chest wall reconstruction&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26 &#40;5&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Tracheal reconstruction&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18 &#40;3&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Esophagectomy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;0&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Pericardiotomy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;0&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Sympathectomy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;0&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Approach&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Video-assisted thoracoscopy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">450 &#40;88&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Thoracotomy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">59 &#40;11&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Muscles&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mean &#40;SD&#41; height-adjusted muscle area in cm<span class="elsevierStyleSup">2</span>&#47;m<span class="elsevierStyleSup">2</span></th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Difference in means &#40;95&#37; CI&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">P value&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Patients presenting outcome&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Patients not presenting outcome&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Outcome&#58; 30-day mortality</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pectorals&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#46;01 &#40;3&#46;30&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&#46;69 &#40;4&#46;29&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;2&#46;62 &#40;&#8722;4&#46;04 to &#8722;1&#46;20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Erector spinae&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#46;23 &#40;1&#46;51&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#46;74 &#40;2&#46;59&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;1&#46;51 &#40;&#8722;2&#46;36 to &#8722;0&#46;67&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Outcome&#58; postoperative pneumonia</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pectorals&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#46;70 &#40;3&#46;43&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&#46;64 &#40;4&#46;40&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;0&#46;94 &#40;&#8722;1&#46;83 to &#8722;0&#46;05&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;039&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Erector spinae&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#46;01 &#40;2&#46;38&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#46;74 &#40;2&#46;57&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;0&#46;72 &#40;&#8722;1&#46;35 to &#8722;0&#46;09&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;025&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Outcome&#58; admission to ICU</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pectorals&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&#46;32 &#40;4&#46;28&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&#46;56 &#40;4&#46;29&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;0&#46;24 &#40;-1&#46;09 &#8211; 0&#46;61&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;578&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Erector spinae&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#46;53 &#40;2&#46;57&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#46;66 &#40;2&#46;55&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;0&#46;13 &#40;-0&#46;64 &#8211; 0&#46;38&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;609&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Outcome&#58; mechanical ventilation</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pectorals&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&#46;32 &#40;4&#46;27&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&#46;55 &#40;4&#46;26&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;0&#46;23 &#40;-1&#46;07&#8722;0&#46;60&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;557&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Erector spinae&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#46;53 &#40;2&#46;57&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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Article information
ISSN: 23411929
Original language: English
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es en pt

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos