The relationship between pre-operative psoas and skeletal muscle parameters and survival following endovascular aneurysm repair: a systematic review and meta-analysis

Abstract

Sarcopenia is characterised by chronically reduced skeletal muscle volume and function, and is determined radiologically by psoas and skeletal muscle measurement. The present systematic review and meta-analysis aims to examine the relationship between pre-operative CT-derived psoas and skeletal muscle parameters and outcomes in patients undergoing EVAR and F/B-EVAR for aortic aneurysm. The MEDLINE database was interrogated for studies investigating the effect of pre-operative CT-diagnosed sarcopenia on outcomes following EVAR and F/B-EVAR. The systematic review was carried out in accordance with PRISMA guidelines. The primary outcome was overall mortality. RevMan 5.4.1 was used to perform meta-analysis. PROSPERO Database Registration Number: CRD42021273085. Ten relevant studies were identified, one reporting skeletal muscle parameters, and the remaining nine reporting psoas muscle parameters, which were used for meta-analysis. There were a total of 2563 patients included (2062 EVAR, 501 F/B-EVAR), with mean follow-up ranging from 25 to 101 months. 836 patients (33%) were defined as radiologically sarcopenic. In all studies, the combined HR for all-cause mortality in sarcopenic versus non-sarcopenic patients was 2.61 (1.67-4.08), p < .001. Two studies reported outcomes on patients undergoing F/B-EVAR; the combined HR for all-cause mortality in sarcopenic versus non-sarcopenic patients was 3.08 (1.66-5.71), p = .004. Radiological sarcopenia defined by psoas or skeletal muscle parameters was associated with inferior survival in patients undergoing both EVAR and F/B-EVAR. Current evidence is limited by heterogeneity in assessment of body composition and lack of a consensus definition of radiological sarcopenia.

Figure 1

PRISMA diagram showing study inclusion. OSR (Open Surgical Repair), EVAR (Endovascular Aneurysm Repair), SMI (Skeletal Muscle Index), PMI (Psoas Muscle Index).

Figure 2

Forest Plot of the risk of post-operative mortality in sarcopenic vs. non-sarcopenic patients undergoing EVAR and F/B-EVAR for each of the included studies. Plots to the right of the X-axis represent an increased risk of mortality in sarcopenic patients.

Figure 3

Forest Plot of the risk of 30 day post-operative mortality in sarcopenic vs. non-sarcopenic patients undergoing EVAR and F/B-EVAR in the included studies. Plots to the right of the X-axis represent an increased risk of mortality in sarcopenic patients.

Figure 4

Forest Plot of the risk of post-operative mortality in sarcopenic vs. non-sarcopenic patients undergoing F/B-EVAR for the included studies. Plots to the right of the X-axis represent an increased risk of mortality in sarcopenic patients.