Morphometric Assessment as a Predictor of Outcome in Older Vascular Surgery Patients

Mohammed M Chowdhury, Graeme K Ambler, Naail Al Zuhir, Alex Walker, Ellie R Atkins, Andrew Winterbottom, Patrick A Coughlin

Research output: Contribution to journalArticle (Academic Journal)peer-review

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Abstract

BACKGROUND: Frailty is a recognized predictor of poor outcome in patients undergoing surgical intervention. Frailty is intricately linked with body morphology, which can be evaluated using morphometric assessment via computerized tomographic (CT) imaging. We aimed to assess the predictive power of such objective assessments in a broad cohort of vascular surgical patients.

METHODS: A consecutive series of patients aged over 65 years admitted to a vascular unit, who had undergone CT imaging of the abdomen, were analyzed. Demographic and patient-specific data were collated alongside admission relevant information. Outcomes included mortality, length of stay, health care-related costs, and discharge destination. Images were analyzed for 4 morphometric measurements: (1) psoas muscle area, (2) mean psoas density, (3) subcutaneous fat depth, and (4) intra-abdominal fat depth, all taken at the level of the fourth lumbar vertebra.

RESULTS: Two hundred and ten patients were initially analyzed. Forty-four patients had significant retroperitoneal and abdominal abnormalities that limited appropriate CT analysis. Decreased subcutaneous fat depth was significantly associated with mortality, readmission within 12 months, and increased cost of health care (P < 0.01, adjusted for confounders). Psoas muscle area was significantly associated with readmission-free survival.

CONCLUSIONS: Morphometric analysis predicts poorer outcome in a broad cohort of vascular surgery patients. Such assessment is likely to enhance patient counseling regarding individual risk as well as enhancing the ability to undertake risk-modified surgical audit.

Original languageEnglish
Pages (from-to)90-97
Number of pages8
JournalAnnals of Vascular Surgery
Volume47
Early online date6 Sep 2017
DOIs
Publication statusPublished - Feb 2018

Keywords

  • Aged
  • Aged, 80 and over
  • Cohort Studies
  • Female
  • Frail Elderly
  • Humans
  • Intra-Abdominal Fat/anatomy & histology
  • Kaplan-Meier Estimate
  • Male
  • Psoas Muscles/anatomy & histology
  • Risk Assessment
  • Risk Factors
  • Sarcopenia/diagnosis
  • Subcutaneous Fat/anatomy & histology
  • Survival Rate
  • Tomography, X-Ray Computed
  • Vascular Surgical Procedures/adverse effects

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