Questioning the Role of Psoas Measurements: Limited Predictive Value for Outcomes After Aortic Repair

Area of Science:

• Vascular Surgery
• Geriatric Medicine
• Radiology

Background:

• Abdominal aortic aneurysm (AAA) repair aims to prevent rupture, but surgical decisions are complex in older, frail patients.
• Psoas muscle area (PMA) and density (PMD) are potential imaging biomarkers for frailty and surgical outcomes in AAA.
• The clinical utility of these psoas muscle indices in predicting AAA repair outcomes remains uncertain.

Purpose of the Study:

• To evaluate the predictive value of psoas muscle indices (PMA, PMD, and lean PMA) for postoperative outcomes in patients undergoing elective AAA repair.
• To determine if sarcopenia, defined by psoas muscle measurements, is associated with complications or mortality after AAA surgery.

Main Methods:

• Retrospective analysis of 199 patients undergoing elective AAA repair (2015-2019).
• Preoperative CT angiography (CTA) used to measure PMA and PMD at L3.
• Lean psoas muscle area (LPMA) calculated; sarcopenia defined by lowest tertile of measurements. Outcomes assessed via Fisher's exact test, Kaplan-Meier, and logistic regression.

Main Results:

• No significant associations were found between PMA, PMD, or LPMA and early or late postoperative complications.
• Psoas muscle indices did not predict mortality after elective AAA repair.
• Sarcopenia, based on psoas muscle measurements, was not a significant predictor of adverse outcomes.

Conclusions:

• Psoas muscle indices derived from routine CTA scans are not reliable predictors of postoperative outcomes in patients undergoing AAA repair.
• Current imaging biomarkers of sarcopenia may not be sufficient for risk stratification in this population.
• Future research should incorporate broader clinical and functional assessments to enhance preoperative decision-making for AAA repair.