CT-determined sarcopenia as a predictor of post-operative outcomes in patients undergoing an emergency laparotomy

Purpose: Emergency laparotomy has a high reported thirty-day mortality, ranging from 11 to 15%. Current perioperative risk assessment tools may poorly estimate the risk of perioperative mortality. We sought to determine if CT-determined sarcopenia may be a useful predictor of post-operative outcomes in patients undergoing an emergency laparotomy. Methods: A retrospective review of a prospectively maintained database of consecutive adult patients who underwent an emergency laparotomy at our institution was performed. Post-operative mortality (90-day mortality), admission to HDU or ICU and APACHE-II scores were recorded for these patients. Sarcopenia was calculated by determining psoas area and density at the level of the third lumbar vertebra. The lowest quartile was determined to be sarcopenic. Univariate statistical analysis investigated associations between sarcopenia and these outcome measures. Results: Eighty patients were included in the study following application of exclusion criteria. Thirty-eight were male. The 90-day mortality rate was 11%. Compared to their non-sarcopenic counterparts, sarcopenic patients were significantly more likely to have died by 90 days post-operatively (chi(2) = 9.51, p = 0.002) and to require admission to either the HDU or ICU in the post-operative period (chi(2) = 10.62, p = 0.001). Conclusions: CT determined sarcopenia is significantly associated with 90-day mortality and post-operative admission to HDU or ICU in patients undergoing an emergency laparotomy. The future development of a validated scoring tool incorporating sarcopenia could help to better select out those patients who will require higher levels of post-operative care as well as identifying those for whom surgery may not confer a survival benefit and be deemed futile.

Automated summary

This retrospective study of 80 patients undergoing emergency laparotomy found a significant association between CT-determined sarcopenia and 90-day mortality as well as post-operative admission to HDU or ICU. Patients with sarcopenia were more likely to experience adverse post-operative outcomes, suggesting the potential for using sarcopenia as a predictor for higher levels of post-operative care.