Sarcopenia Increases Risk of Long-Term Mortality in Elderly Patients Undergoing Emergency Abdominal Surgery.

Background: Frailty is associated with poor surgical outcomes in elderly patients but is difficult to measure in the emergency setting. Sarcopenia, or the loss of lean muscle mass, is a surrogate for frailty and can be measured using cross-sectional imaging. We sought to determine the impact of sarcopenia on one-year mortality after emergency abdominal surgery in elderly patients. Methods: Sarcopenia was assessed in patients >=70 years old who underwent emergency abdominal surgery at a single hospital from 2006-2011. Average bilateral psoas muscle cross-sectional area at L3, normalized for height (Total Psoas Index;TPI), was calculated using CT. Sarcopenia was defined as TPI in the lowest sex-specific quartile. Primary outcome was mortality at 1 year. Secondary outcomes were in-hospital mortality and mortality at 30, 90, and 180 days. The association of sarcopenia with mortality was assessed using Cox proportional hazards regression and model performance judged using Harrell's C-statistic. Results: 297 of 390 emergency abdominal surgery patients had preoperative imaging and height. The median age was 79 years and one-year mortality was 32%. Sarcopenic and non-sarcopenic patients were comparable in age, gender, race, comorbidities, American Society of Anesthesiologists classification, procedure urgency and type, operative severity, and need for discharge to a nursing facility. Sarcopenic patients had lower BMI, greater need for intensive care, and longer hospital length of stay (p

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