PURPOSE 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. METHODS 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. RESULTS 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. CONCLUSION 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.

中文翻译：

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肌肉减少症预测接受紧急腹部手术的老年患者90天死亡率。

目的基于图像的肌肉减少症的测量是多种外科手术结果降低的公认指标。对进行急诊腹部手术的老年患者的肌肉减少症尚未进行充分的研究。这项研究旨在调查一组老年急诊剖腹手术患者在90天后总腰大肌面积（TPA）与术后死亡率之间的关系。方法我们回顾性分析了来自我们手术中心连续腹部急诊手术的150名老年患者的紧急CT扫描。TPA是在L3的水平上手动测量的，并与患者身高挂钩。肌肉减少症的定义为TPA指数低于该队列中性别的第一个四分位数。其他收集的变量包括年龄，生命状态/死亡日期，ASA评分，手术程序，和WHO绩效得分。结果90天总死亡率为42.7％。肌肉减少症患者的90天死亡率（60.5％）高于非肌肉减少症患者（36.6％），比值比为2.66（95％置信区间1.2-5.7，p = 0.01）。与非肌肉减少症患者相比，肌肉减少症患者的死亡率增加（p = 0.0009，对数秩检验），两组在术后30天内明确分开。在以年龄，ASA评分和WHO成绩得分为协变量的多元logistic回归模型中，肌肉减少症与90天死亡率独立相关。结论在腹部CT扫描中手动测量TPA是高危急诊腹部手术老年患者术后死亡率的相关危险因素。