Low Total Psoas Area as Scored in the Clinic Setting Independently Predicts Midterm Mortality After Endovascular Aneurysm Repair in Male Patients

J Vasc Surg. 2018 Feb;67(2):460-467. doi: 10.1016/j.jvs.2017.06.085. Epub 2017 Aug 23.


Objective: Preoperative sarcopenia is an established risk factor for poor outcomes after surgery. Methods for assessing sarcopenia are either complex, time consuming, or poorly validated. We aimed to assess the interobserver reliability of scoring psoas area at the level of the L3 vertebra and to evaluate whether sarcopenia scored by this simple and rapid method correlated with other fitness scoring methods or impacted on mortality and duration of stay for patients undergoing endovascular aneurysm repair (EVAR).

Methods: We had access to 191 preoperative computed tomography scans of patients who underwent EVAR. For each scan the axial slice at the most caudal level of the L3 vertebra was extracted. Three observers independently calculated the combined cross-sectional area of the left and right psoas muscle at this level. Interobserver variability was calculated as per Band and Altman. Psoas area was normalized for patient height with sarcopenia defined as total psoas area of <500 mm2/m2. The effect of sarcopenia on patient survival was assessed using Cox proportional hazards models. Kaplan-Meier curves are also presented.

Results: Interobserver reliability of scoring psoas area was acceptable (reproducibility coefficient as percent of mean for each observer pair: 7.92%, 7.95%, and 14.33%). Sarcopenic patients had poorer survival (hazard ratio, 2.37; P = .011) and an increased hospital duration of stay (4.0 days vs 3.0 days; P = .008) when compared with nonsarcopenic patients. Sarcopenic patients were more likely to self-report as unfit (12.4% vs 33.3%; P = .004). Sarcopenia did not correlate with an increased rate of postprocedure complications.

Conclusions: Psoas area scoring has good interobserver reliability. Preoperative sarcopenia as defined by psoas area was associated with poorer survival and of longer length of stay. As all patients being worked up for an endovascular aortic aneurysm repair will undergo a computed tomography scan, this method is a rapid and effective way to highlight patients in the clinic setting who have an increased risk of morbidity and mortality after EVAR.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aortic Aneurysm, Abdominal / diagnostic imaging
  • Aortic Aneurysm, Abdominal / mortality
  • Aortic Aneurysm, Abdominal / surgery*
  • Aortography / methods*
  • Australia
  • Blood Vessel Prosthesis Implantation / adverse effects
  • Blood Vessel Prosthesis Implantation / mortality*
  • Chi-Square Distribution
  • Databases, Factual
  • Endovascular Procedures / adverse effects
  • Endovascular Procedures / mortality*
  • Frailty / diagnostic imaging
  • Frailty / mortality*
  • Health Status
  • Humans
  • Kaplan-Meier Estimate
  • Length of Stay
  • Male
  • Observer Variation
  • Postoperative Complications / mortality
  • Predictive Value of Tests
  • Proportional Hazards Models
  • Psoas Muscles / diagnostic imaging*
  • Reproducibility of Results
  • Retrospective Studies
  • Risk Factors
  • Sarcopenia / diagnostic imaging
  • Sarcopenia / mortality*
  • Self Report
  • Time Factors
  • Tomography, X-Ray Computed*
  • Treatment Outcome