Related Experiment Video
Updated: Jun 13, 2026
Posterior Approach for Debridement of the Psoas Abscess
Published on: March 2, 2020
Lean Psoas Muscle Area Is Associated with Length of Stay After Lower Limb Revascularization for CLTI
Jagoda Bobula1, Joanna Halman2, Kamil Myszczyński3
1Student Scientific Circle of Vascular Surgery, Faculty of Medicine, Medical University of Gdansk, 80-210 Gdansk, Poland.
Insights
Lean psoas muscle area (LPMA) measured on CT scans may predict shorter hospital stays for chronic limb-threatening ischemia (CLTI) patients undergoing revascularization. This imaging marker could help assess patient recovery potential.
Area of Science:
- Vascular Surgery
- Radiology
- Geriatric Medicine
Background:
- Chronic limb-threatening ischemia (CLTI) presents significant morbidity and healthcare costs.
- Hospital length of stay (LOS) after lower limb revascularization is influenced by procedure complexity and patient physiological reserve.
- Assessing patient physiological reserve is crucial for managing CLTI outcomes.
Purpose of the Study:
- To investigate the independent association between CT-derived lean psoas muscle area (LPMA) and LOS in patients undergoing lower limb revascularization for CLTI.
- To determine if LPMA can serve as a predictor of hospitalization duration.
- To explore imaging-based markers of physiological reserve in high-risk CLTI patients.
Main Methods:
- Retrospective analysis of 234 CLTI patients (Rutherford 4-5) who underwent revascularization between 2018-2021.
- Preoperative CT scans at L3 level were used to derive sarcopenia markers: psoas muscle area (PMA), muscle density (PMD), and LPMA.
- Multivariable linear regression models with log-transformed LOS were employed to assess factors influencing hospitalization duration.
Main Results:
- Median LOS was 6 days; hybrid and open revascularization were associated with significantly longer LOS than endovascular treatment.
- Higher LPMA was independently associated with shorter LOS (β = -0.00049, p = 0.004).
- Smoking and history of myocardial infarction were also linked to shorter LOS, while dialysis showed a trend toward longer hospitalization.
Conclusions:
- CT-derived LPMA is modestly but independently associated with shorter hospital stay duration in CLTI patients undergoing revascularization.
- LPMA may serve as an adjunct imaging marker for physiological reserve in this high-risk population.
- Further research is warranted to validate these hypothesis-generating findings and explore the clinical utility of imaging-based muscle assessment.
Abstract:
Background: Chronic limb-threatening ischemia (CLTI) is associated with high morbidity and substantial healthcare utilization. Length of hospital stay (LOS) after lower limb revascularization is influenced by procedural complexity, but patient physiological reserve may also play a role. We evaluated whether CT-derived lean psoas muscle area (LPMA) is independently associated with LOS in patients undergoing revascularization for CLTI. Methods: We retrospectively analyzed 234 consecutive patients treated with endovascular, hybrid, or open revascularization for CLTI (Rutherford 4-5) between 2018 and 2021. Sarcopenia markers were derived from preoperative CT at the L3 level, including psoas muscle area (PMA), muscle density (PMD), and LPMA. Multivariable linear regression models with log-transformed LOS were used to estimate relative effects on hospitalization duration. Results: Median age was 68 years and 65.4% were male; 76.5% of admissions were urgent. Median LOS was 6 days (IQR 4-9). Procedure type was the strongest determinant of LOS: hybrid (β = 0.69, p < 0.001) and open surgery (β = 0.73, p < 0.001) were associated with approximately 99% and 108% longer LOS compared with endovascular treatment. Higher LPMA was independently associated with shorter LOS (β = -0.00049, p = 0.004). Smoking (β = -0.21, p = 0.003) and history of myocardial infarction (β = -0.19, p = 0.030) were associated with shorter LOS, whereas dialysis showed a non-significant trend toward longer hospitalization (β = 0.36, p = 0.056). Conclusions: In patients undergoing lower limb revascularization for CLTI, CT-derived LPMA demonstrated a modest but independent association with hospital stay duration after adjustment for procedural and clinical factors. Given the exploratory nature of this study, these hypothesis-generating findings support further evaluation of imaging-based muscle assessment as an adjunct marker of physiological reserve in this high-risk population.
