Oral Virtual Presentation (Virtual only) ESA-SRB-ANZBMS 2021

Lower Psoas Muscle Area is associated with increased mortality after endovascular aneurysm repair in older adults   (#51)

Jiuan Ting 1 , Charles Inderjeeth 2 , Kien Chan 1 , Warren Raymond 3 , Joy Lu 1 , Ricky Kwok 1 , Shirley Jansen 2
  1. Sir Charles Gairdner Hospital, Perth, WA, Australia
  2. North Metropolitan Health and University of Western Australia, Nedlands, WA, Australia
  3. WARDER, University of Western Australia, Perth, WA, Australia

611f702738b37-Figure+used+ANZBMS+2021Untitled.jpgIntroduction: Psoas muscle area (PMA) is an easily measured surrogate marker of sarcopenia.  However, evidence is conflicted as to whether PMA is associated with poorer post-operative outcomes. This study aimed to further explore the relationship between PMA and outcomes post asymptomatic infrarenal endovascular aortic repair of aneurysm (EVAR).

Methods: A retrospective observational study reviewed people aged over 65 years undergoing EVAR from 1/1/2013 to 31/12/2017. PMA was measured at mid L4 vertebral body on preoperative computer tomography scan. Primary outcome was survival in days from operation. Secondary outcomes were 30-day readmissions related to EVAR, post-operative complications and length of stay measured in days.

Results: Ninety-seven patients (mean age 77.5 years, 78% male) were assessed. Patients in the lowest PMA tertile had an increased unadjusted 5-year mortality (HR 2.31, 95%CI 1.02-5.24, p=0.045). Adjustment for BMI showed also an increased 5-year mortality (HR 2.91, 95%CI 1.16-7.34, p=0.023). Adjustment for age, sex and BMI also showed that patients in the lowest PMA tertile had an increased 5-year mortality (HR 2.76, 95%CI 1.08, 7.03; P=0.034). Adjustment for frailty, in the form of modified frailty index, showed only a minimal attenuation of the association (HR 2.30, 95%CI 0.99, 5.34; p=0.054).

After adjusting for BMI patients with the lowest tertiles of PMA for either sex had increased total LOS (β 0.33, 95%CI 0.04, 0.63; P=0.028). Risk of death was also increased (OR 3.53, 95%CI 1.21, 10.27: P=0.021). 30-day readmissions, complications and discharge destination were not influenced by PMA.

Conclusion: The lowest tertile of PMA, as a surrogate marker for sarcopenia, was associated with increased mortality in patients undergoing EVAR. Adjustment for frailty showed a minimal attenuation of this association Although sarcopenia is a complex phenomenon and the literature surrounding it is still evolving, PMA may form one component of risk assessment in patients undergoing EVAR.