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. 2019 Mar;106(4):367-374.
doi: 10.1002/bjs.11074. Epub 2019 Jan 31.

Influence of psoas muscle area on mortality following elective abdominal aortic aneurysm repair

M A Waduud  1 , B Wood  1 , P Keleabetswe  1 , J Manning  2 , E Linton  1 , M Drozd  2 , C J Hammond  1 , M A Bailey  2 , D J A Scott  1 ; vascular surgeons and interventional radiologists at the Leeds Vascular Institute
Affiliations

Influence of psoas muscle area on mortality following elective abdominal aortic aneurysm repair

M A Waduud et al. Br J Surg. 2019 Mar.

Abstract

Background: The effect of sarcopenia based on the total psoas muscle area (TPMA) on CT is inconclusive in patients undergoing abdominal aortic aneurysm (AAA) intervention. The aim of this prospective cohort study was to evaluate morphometric sarcopenia as a method of risk stratification in patients undergoing elective AAA intervention.

Methods: TPMA was measured on preintervention CT images of patients undergoing elective endovascular aneurysm repair (EVAR) or open aneurysm repair. Mortality was assessed in relation to preintervention TPMA using Cox regression analysis, with calculation of hazard ratios at 30 days, 1 year and 4 years. Postintervention morbidity was evaluated in terms of postintervention care, duration of hospital stay and 30-day readmission. Changes in TPMA on surveillance EVAR imaging were also evaluated.

Results: In total, 382 patient images acquired between March 2008 and December 2016 were analysed. There were no significant intraobserver and interobserver differences in measurements of TPMA. Preintervention TPMA failed to predict morbidity and mortality at all time points. The mean(s.d.) interval between preintervention and surveillance imaging was 361·3(111·2) days. A significant reduction in TPMA was observed in men on surveillance imaging after EVAR (mean reduction 0·63(1·43) cm2 per m2 ; P < 0·001). However, this was not associated with mortality (adjusted hazard ratio 1·00, 95 per cent c.i. 0·99 to 1·01; P = 0·935).

Conclusion: TPMA is not a suitable risk stratification tool for patients undergoing effective intervention for AAA.

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Figures

Graphical Abstract
Graphical Abstract
Fig. 1
Fig. 1
Cross-sectional measurement of the total psoas muscle area on CT angiography. X denotes the right psoas
Fig. 2
Fig. 2
Flow chart illustrating the inclusion and exclusion of patients identified from the National Vascular Registry (NVR). AAA, abdominal aortic aneurysm; EVAR, endovascular aneurysm repair; OAR, open aneurysm repair
Fig. 3
Fig. 3
Bland–Altman analysis of intraobserver and interobserver agreement in total psoas muscle area (TPMA) measurements. a Intraobserver and b interobserver differences in TPMA measurements. Solid and dashed lines represent the mean and limits of agreement respectively. R1a and R1b, first and second measurements from the first reader; R2, single measurement by the second reader
Fig. 4
Fig. 4
Kaplan–Meier curves showing survival in relation to total psoas muscle area (TPMA). a By TPMA tertiles and b by defined cut-off values
Fig. 5
Fig. 5
Scatter plot illustrating relationship between standardized preintervention total psoas muscle area (TPMA) and age
See this image and copyright information in PMC

Comment in

  • Correspondence.
    Waduud MA, Drozd M. Waduud MA, et al. Br J Surg. 2019 Jun;106(7):951-952. doi: 10.1002/bjs.11211. Br J Surg. 2019. PMID: 31162651 No abstract available.
  • Correspondence.
    Wardle BG, Ambler GK, Twine CP, Coughlin PA. Wardle BG, et al. Br J Surg. 2019 Jun;106(7):951. doi: 10.1002/bjs.11212. Br J Surg. 2019. PMID: 31162665 No abstract available.

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