Psoas Muscle Area and All-Cause Mortality After Endovascular and Open Aortic Aneurysm Repair

Abstract

We sought to determine if psoas muscle area (PMA) was associated with postoperative mortality after endovascular or open aortic aneurysm repair. Consecutive patients who underwent elective endovascular or open aortic aneurysm repair between 2010 and 2015 were included in the analysis. Preoperative computed tomography scan images were analyzed with the CoreSlicer.com semiautomated software tool to measure and to add the cross-sectional area of the left and right psoas muscles at the axial level of the L4 vertebra. Measurements were made by two independent observers blinded to clinical data. The primary end point was all-cause mortality. The cohort consisted of 149 patients with a mean age of 78.7 ± 7.1 years. The mean PMA was 24.0 ± 5.8 cm2 in men and 14.3.0 ± 3.1 cm2 in women. There were 33 deaths during a mean follow-up of 682 days. After adjusting for age, sex, revised cardiac risk index, and surgical approach, Cox regression revealed a graded association between low PMA and all-cause mortality (Fig) with a hazard ratio of 0.86/cm2 (95% confidence interval, 0.79-0.93). PMA is independently associated with all-cause mortality after elective endovascular and open aortic aneurysm repair and may be integrated in the preoperative risk assessment to identify and to optimize high-risk frail patients.