Abdominal Radiology

, Volume 44, Issue 3, pp 1155–1160 | Cite as

Sarcopenia predicts 90-day mortality in elderly patients undergoing emergency abdominal surgery

  • Erik BrandtEmail author
  • Line Toft Tengberg
  • Morten Bay-Nielsen
Hollow Organ GI



Image-based measurement of sarcopenia is an established predictor of a decreased outcome for a large variety of surgical procedures. Sarcopenia in elderly patients undergoing emergency abdominal surgery has not been well studied. This study aims to investigate the association between the total psoas area (TPA) and postoperative mortality after 90 days in a group of elderly emergency laparotomy patients.


We retrospectively reviewed the emergency CT-scans of 150 elderly patients from a consecutive cohort undergoing emergency abdominal surgery at our surgical center. TPA was measured manually at the level of L3 and indexed to patient height. Sarcopenia was defined as having a TPA index below the first quartile for gender in the cohort. Other collected variables were age, vital status/date of death, ASA-score, surgical procedure, and WHO performance score.


Overall 90-day mortality was 42.7%. Sarcopenic patients had a higher 90-day mortality (60.5%) than non-sarcopenic patients (36.6%), corresponding to an odds ratio of 2.66 (95% confidence interval 1.2–5.7, p = 0.01). Sarcopenic patients had an increased mortality compared with non-sarcopenic patients (p = 0.0009, Log-rank test), with a clear separation of the two groups within 30 days postoperatively. In a multivariate logistic regression model, with age, ASA-score, and WHO performance score as covariates, sarcopenia was independently associated with 90-day mortality.


Manual measurement of TPA on an abdominal CT-scan is a relevant risk factor for postoperative mortality in elderly patients undergoing high-risk emergency abdominal surgery. Incorporation of sarcopenia in postoperative risk-prediction models in emergency abdominal surgery should be considered.


Acute surgery Gastrointestinal surgery Radiology Sarcopenia 



This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Compliance with ethical standards

Conflict of interest

The authors declare that there is no conflict of interest.


  1. 1.
    M.A. Makary, D.L. Segev, P.J. Pronovost, D. Syin, K. Bandeen-Roche, P. Patel, R. Takenaga, L. Devgan, C.G. Holzmueller, J. Tian, L.P. Fried, Frailty as a predictor of surgical outcomes in older patients., J. Am. Coll. Surg. 210 (2010) 901–8. CrossRefGoogle Scholar
  2. 2.
    L.P. Fried, C.M. Tangen, J. Walston, A.B. Newman, C. Hirsch, J. Gottdiener, T. Seeman, R. Tracy, W.J. Kop, G. Burke, M.A. McBurnie, Frailty in Older Adults: Evidence for a Phenotype, Journals Gerontol. Ser. A Biol. Sci. Med. Sci. 56 (2001) M146–M157. Google Scholar
  3. 3.
    D. Wagner, Role of frailty and sarcopenia in predicting outcomes among patients undergoing gastrointestinal surgery, World J. Gastrointest. Surg. 8 (2016) 27. doi:10.4240/wjgs.v8.i1.27. CrossRefGoogle Scholar
  4. 4.
    N. Amini, G. Spolverato, R. Gupta, G.A. Margonis, Y. Kim, D. Wagner, N. Rezaee, M.J. Weiss, C.L. Wolfgang, M.M. Makary, I.R. Kamel, T.M. Pawlik, Impact Total Psoas Volume on Short- and Long-Term Outcomes in Patients Undergoing Curative Resection for Pancreatic Adenocarcinoma: a New Tool to Assess Sarcopenia, J. Gastrointest. Surg. 19 (2015) 1593–1602. CrossRefGoogle Scholar
  5. 5.
    B.C. Boer, F. de Graaff, M. Brusse-Keizer, D.E. Bouman, C.H. Slump, M. Slee-Valentijn, J.M. Klaase, Skeletal muscle mass and quality as risk factors for postoperative outcome after open colon resection for cancer, Int. J. Colorectal Dis. 31 (2016) 1117–1124. CrossRefGoogle Scholar
  6. 6.
    K.W. Reisinger, J.L.A. Van Vugt, J.J.W. Tegels, C. Snijders, K.W.E. Hulsewé, A.G.M. Hoofwijk, J.H. Stoot, M.F. Von Meyenfeldt, G.L. Beets, J.P.M. Derikx, M. Poeze, Functional compromise reflected by sarcopenia, frailty, and nutritional depletion predicts adverse postoperative outcome after colorectal cancer surgery, Ann. Surg. 261 (2015) 345–352. CrossRefGoogle Scholar
  7. 7.
    R.C. Dirks, B.L. Edwards, E. Tong, B. Schaheen, F.E. Turrentine, A. Shada, P.W. Smith, Sarcopenia in emergency abdominal surgery., J. Surg. Res. 207 (2017) 13–21. CrossRefGoogle Scholar
  8. 8.
    W. Shen, Total body skeletal muscle and adipose tissue volumes: estimation from a single abdominal cross-sectional image, J. Appl. Physiol. 97 (2004) 2333–2338. CrossRefGoogle Scholar
  9. 9.
    R.J. Wilson, V.K. Alamanda, K.G. Hartley, N.W. Mesko, J.L. Halpern, H.S. Schwartz, G.E. Holt, Sarcopenia Does Not Affect Survival or Outcomes in Soft-Tissue Sarcoma, Sarcoma. 2015 (2015).
  10. 10.
    H. Gakhar, A. Dhillon, J. Blackwell, K. Hussain, R. Bommireddy, Z. Klezl, J. Williams, Study investigating the role of skeletal muscle mass estimation in metastatic spinal cord compression, Eur. Spine J. 24 (2015) 2150–2155. CrossRefGoogle Scholar
  11. 11.
    H. Hentati, C. Salloum, P. Caillet, E. Lahat, M. Disabato, E. Levesque, P. Compagnon, C. Lim, D. Azoulay, Risk Factors for Mortality and Morbidity in Elderly Patients Presenting with Digestive Surgical Emergencies, World J. Surg. (2017) 1–9.
  12. 12.
    K. Jones, A. Gordon-Weeks, C. Coleman, M. Silva, Radiologically Determined Sarcopenia Predicts Morbidity and Mortality Following Abdominal Surgery: A Systematic Review and Meta-Analysis, World J. Surg. 41 (2017) 2266–2279. CrossRefGoogle Scholar
  13. 13.
    M. Kadan, C. Haymana, U. Safer, Psoas cross sectional area measurement for sarcopenia., Colorectal Dis. 17 (2015) 172.
  14. 14.
    J.S.J. Lee, K. He, C.M. Harbaugh, D.E. Schaubel, C.J. Sonnenday, S.C. Wang, M.J. Englesbe, J.L. Eliason, Frailty, core muscle size, and mortality in patients undergoing open abdominal aortic aneurysm repair, J. Vasc. Surg. 53 (2011) 912–917. CrossRefGoogle Scholar
  15. 15.
    T.D. Lyon, N.J. Farber, L.C. Chen, T.W. Fuller, B.J. Davies, J.R. Gingrich, R.L. Hrebinko, J.K. Maranchie, J.M. Taylor, T. V. Tarin, Total Psoas Area Predicts Complications following Radical Cystectomy, Adv. Urol. 2015 (2015).
  16. 16.
    G.R. Morrell, T.A. Ikizler, X. Chen, M.E. Heilbrun, G. Wei, R. Boucher, S. Beddhu, Psoas Muscle Cross-sectional Area as a Measure of Whole-body Lean Muscle Mass in Maintenance Hemodialysis Patients., J. Ren. Nutr. 26 (2016) 258–64. CrossRefGoogle Scholar
  17. 17.
    E.L. Rangel, A.J. Rios-Diaz, J.W. Uyeda, M. Castillo-Angeles, Z. Cooper, O.A. Olufajo, A. Salim, A.D. Sodickson, Sarcopenia increases risk of long-term mortality in elderly patients undergoing emergency abdominal surgery, in: J. Trauma Acute Care Surg., 2017: pp. 1179–1186.
  18. 18.
    R. Hasselager, I. Gögenur, Core muscle size assessed by perioperative abdominal CT scan is related to mortality, postoperative complications, and hospitalization after major abdominal surgery: A systematic review, Langenbeck’s Arch. Surg. 399 (2014) 287–295. CrossRefGoogle Scholar
  19. 19.
    C.M. Leeper, E. Lin, M. Hoffman, A. Fombona, T. Zhou, M. Kutcher, M. Rosengart, G. Watson, T. Billiar, A. Peitzman, B. Zuckerbraun, J. Sperry, Computed tomography abbreviated assessment of sarcopenia following trauma: The CAAST measurement predicts 6-month mortality in older adult trauma patients, in: J. Trauma Acute Care Surg., 2016.
  20. 20.
    S.J. Kaplan, T.N. Pham, S. Arbabi, J.A. Gross, M. Damodarasamy, I. Bentov, L.A. Taitsman, S.H. Mitchell, M.J. Reed, Association of radiologic indicators of frailty with 1-year mortality in older trauma patients: Opportunistic screening for sarcopenia and osteopenia, JAMA Surg. (2017).
  21. 21.
    M. Murea, L. Lenchik, T.C. Register, G.B. Russell, J. Xu, S.C. Smith, D.W. Bowden, J. Divers, B.I. Freedman, Psoas and paraspinous muscle index as a predictor of mortality in African American men with type 2 diabetes mellitus, J. Diabetes Complications. (2018).
  22. 22.
    L. Lenchik, K.M. Lenoir, J. Tan, R.D. Boutin, K.E. Callahan, S.B. Kritchevsky, B.J. Wells, Opportunistic Measurement of Skeletal Muscle Size and Muscle Attenuation on Computed Tomography Predicts One-year Mortality in Medicare Patients., J. Gerontol. A. Biol. Sci. Med. Sci. (2018).
  23. 23.
    L.T. Tengberg, M. Bay-Nielsen, T. Bisgaard, M. Cihoric, M.L. Lauritsen, N.B. Foss, J. Orbæk, L. Veyhe, H. Jørgen Nielsen, L. Lindgaard, Multidisciplinary perioperative protocol in patients undergoing acute high-risk abdominal surgery, Br. J. Surg. 104 (2017) 463–471.
  24. 24.
    C.C. Peyton, M.G. Heavner, J.T. Rague, L.S. Krane, A.K. Hemal, Does Sarcopenia Impact Complications and Overall Survival in Patients Undergoing Radical Nephrectomy for Stage III and IV Kidney Cancer?, J. Endourol. 30 (2016) 229–236. CrossRefGoogle Scholar
  25. 25.
    P.D. Peng, M.G. Van Vledder, S. Tsai, M.C. De Jong, M. Makary, J. Ng, B.H. Edil, C.L. Wolfgang, R.D. Schulick, M.A. Choti, I. Kamel, T.M. Pawlik, Sarcopenia negatively impacts short-term outcomes in patients undergoing hepatic resection for colorectal liver metastasis, HPB. 13 (2011) 439–446. CrossRefGoogle Scholar
  26. 26.
    K. Takagi, R. Yoshida, T. Yagi, Y. Umeda, D. Nobuoka, T. Kuise, T. Fujiwara, Radiographic sarcopenia predicts postoperative infectious complications in patients undergoing pancreaticoduodenectomy, BMC Surg. 17 (2017) 64. CrossRefGoogle Scholar
  27. 27.
    Y. Du, C.J. Karvellas, V. Baracos, D.C. Williams, R.G. Khadaroo, Sarcopenia is a predictor of outcomes in very elderly patients undergoing emergency surgery, Surg. (United States). 156 (2014) 521–527. Google Scholar
  28. 28.
    J. Trotter, J. Johnston, A. Ng, M. Gatt, J. MacFie, C. McNaught, Is sarcopenia a useful predictor of outcome in patients after emergency laparotomy? A study using the NELA database., Ann. R. Coll. Surg. Engl. 100 (2018) 377–381. CrossRefGoogle Scholar
  29. 29.
    S. Taguchi, N. Akamatsu, T. Nakagawa, W. Gonoi, A. Kanatani, H. Miyazaki, T. Fujimura, H. Fukuhara, H. Kume, Y. Homma, Sarcopenia Evaluated Using the Skeletal Muscle Index Is a Significant Prognostic Factor for Metastatic Urothelial Carcinoma, Clin. Genitourin. Cancer. 14 (2016) 237–243. CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of RadiologyHvidovre HospitalHvidovreDenmark
  2. 2.Department of Surgery, Zealand University HospitalUniversity of CopenhagenKøgeDenmark
  3. 3.Gastroenheden, Hvidovre HospitalHvidovreDenmark
  4. 4.Department of Radiology XCopenhagen CDenmark

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