Sarcopenia 'made simple' and outcomes from emergency laparotomy

Area of Science:

• Surgical oncology
• Radiology
• Geriatric medicine

Background:

• Emergency Laparotomy (EL) is a high-risk surgery associated with significant mortality.
• Established risk assessment tools (NELA, P-POSSUM, ACS-NSQIP) are complex and limited in practical application.
• Sarcopenia is linked to adverse surgical outcomes.

Purpose of the Study:

• To investigate the association between radiological sarcopenia and mortality in Australian Emergency Laparotomy patients.
• To evaluate the utility of a simple radiological sarcopenia measure (PM:L3 ratio) as a predictor of mortality.

Main Methods:

• Retrospective analysis of 500 EL patients from four Australian hospitals (2016-2017).
• Measurement of radiological sarcopenia using the psoas muscle area to L3 vertebral body cross-sectional area ratio (PM:L3) from CT scans.
• Follow-up for up to 12 months to assess 30-, 90-, and 365-day mortality.

Main Results:

• The PM:L3 ratio was significantly associated with 30-, 90-, and 365-day mortality (P < 0.001).
• Radiological sarcopenia showed a weak negative correlation with established risk scores (NELA, P-POSSUM, ACS-NSQIP).
• Established risk assessment tools were significantly correlated with each other.

Conclusions:

• CT-assessed radiological sarcopenia (PM:L3) is a significant predictor of mortality in Australian EL patients.
• The PM:L3 metric demonstrates potential equivalence to established, more complex risk assessment tools.
• The easily accessible and potentially automatable PM:L3 metric may offer significant clinical utility.