Psoas Muscle Density as a Predictor of Postoperative Functional Status and Long-term Survival in Ruptured Abdominal Aortic Aneurysm.

BACKGROUND: Ruptured abdominal aortic aneurysm (rAAA) carries high mortality and functional decline among survivors. Psoas muscle density (PMD) measured via preoperative computed tomography (CT) may serve as a proxy for sarcopenia-related frailty, and may predict outcomes after rAAA. This study evaluated the association between preoperative PMD and long-term survival in patients undergoing emergent rAAA repair.

METHODS: In this single-center retrospective cohort study, patients undergoing emergency rAAA repair between 2009 and 2023 were included. PMD was assessed on CT at the third lumbar vertebra. Patients were classified as high or low density based on sex-specific thresholds (males: 40.3 Hounsfield Units (HU); females: 31.01 HU). The primary outcome was long-term survival; secondary outcomes included in-hospital mortality and postoperative decline in activities of daily living (ADLs), defined as a change from preoperative independence (Barthel Index ≥85) to postoperative dependence (<85).

RESULTS: Fifty-seven patients (median age: 75 years; 60% male); 36 had high PMD and 21 patients had low PMD. The low-density group had significantly lower long-term survival (log-rank P < 0.01) and more frequent postoperative ADL decline, with lower Barthel Index scores at discharge (P = 0.02). Low PMD was associated with higher odds of ADL decline (odds ratio 6.57, 95% confidence interval 1.68-25.78).

CONCLUSION: Low preoperative PMD was associated with reduced long-term survival and postoperative ADL decline in patients with rAAA. PMD may serve as a practical marker of sarcopenia-related frailty, and early identification of patients with low density can guide rehabilitation planning to support functional recovery.