Preoperative CT-Based Pelvic Sarcopenia and Subcutaneous Adiposity Are Associated with Anaemia and Operative Time in Acetabular Fracture Surgery: A Retrospective Cohort Study.

Background and

Objectives

Acetabular fracture surgery is associated with substantial perioperative blood loss and prolonged operative time. Routine preoperative pelvic computed tomography (CT) carries information about body composition that is not currently exploited for risk stratification. We tested whether (i) CT-defined pelvic sarcopenia is associated with lower preoperative haemoglobin and (ii) preoperative subcutaneous fat cross-sectional area (CSA) is independently associated with operative time, after adjustment for surgical approach, age, fracture complexity and sarcopenia status. Materials and

Methods

In this single-centre retrospective cohort study, 48 adults (37 men, 11 women; mean age 40.2 ± 16.5 years) who underwent open reduction and internal fixation (ORIF) for unilateral acetabular fractures between 2016 and 2024 were included. Pelvic muscle and subcutaneous fat CSAs were measured on the contralateral side of preoperative CT images using ImageJ. Sarcopenia was defined as an internal, cohort-relative classification based on the sex-specific bottom tertile of psoas CSA. Normality was assessed by Shapiro-Wilk testing; Pearson or Spearman correlation was used accordingly, and the 36 pairwise correlations were controlled with the Benjamini-Hochberg false-discovery-rate procedure. The multivariable model used ordinary least squares regression with heteroscedasticity-consistent (HC3) standard errors and a median quantile-regression robustness check.

Results

Sarcopenic patients (n = 17) had significantly lower preoperative haemoglobin (12.63 ± 1.24 vs. 14.00 ± 1.53 g/dL; p = 0.002; Cohen's d = 0.96). The absolute perioperative haemoglobin drop was numerically smaller in the sarcopenic group (ΔHb 1.64 ± 0.91 vs. 2.46 ± 1.87 g/dL) but did not reach statistical significance (p = 0.079); estimated blood loss (p = 0.258) and transfusion requirement (p = 0.567) did not differ between groups. Pelvic muscle CSAs correlated positively with preoperative haemoglobin (all q < 0.05 after Benjamini-Hochberg correction). In the multivariable model (F[6, 41] = 3.71, p = 0.005; adjusted R2 = 0.26; all variance inflation factors 1.06-1.26), subcutaneous fat CSA (B = +0.25 min/cm2, p = 0.004) and the modified Stoppa approach (vs. Kocher-Langenbeck; +65 min, p = 0.001) were independently associated with operative time.

Conclusions

In this exploratory retrospective cohort, routine preoperative pelvic CT contained two body-composition signals that may warrant prospective evaluation: pelvic sarcopenia, which was associated with lower baseline haemoglobin, and subcutaneous adiposity, which was associated with longer operative time in the primary regression model. Both signals require confirmation-the sarcopenia-bleeding relationship was not statistically significant, and the subcutaneous fat association was attenuated under robust inference. These findings are hypothesis-generating; prospective multicentre validation with height-normalised sarcopenia thresholds and body mass index is required before clinical implementation.