title: Psoas Muscle Area Predicts All-Cause Mortality After Endovascular and Open Aortic Aneurysm Repair.
abstract: Psoas muscle area (PMA) is a validated surrogate for muscle mass that can be easily measured from a clinical CT scan. This study sought to determine whether PMA was associated with post-operative mortality after endovascular or open aortic aneurysm repair.
  
  
  
  A retrospective review was undertaken of patients who underwent elective endovascular or open aortic aneurysm repair between 2010 and 2015 at a tertiary vascular center in Montreal, Quebec, Canada. Pre-operative CT scan images were analyzed with the CoreSlicer.com software tool to measure PMA at the axial level of the L4 vertebrae. Measurements were made by two independent observers blinded to clinical data. The primary endpoint was all-cause mortality.
  
  
  
  The cohort consisted of 149 patients with a mean age of 75.6 ± 8.8 years. The mean PMA was 24.0 ± 5.8 cm2in males, and 14.3 ± 3.1 cm2in females. There were 31 deaths over a mean follow-up of 22.4 months. After adjusting for age, sex, revised cardiac risk index, and surgical approach, Cox regression revealed a graded association between PMA and all-cause mortality with a hazard ratio of 0.86 per cm2(95% CI 0.79-0.93). Addition of PMA to the model with the clinical covariates resulted in an improvement in C-statistic from 0.57 to 0.67, and BIC from 307 to 301 (with lower BIC values preferred).
  
  
  
  PMA is independently associated with all-cause mortality after elective endovascular and open aortic aneurysm repair, and may be integrated into the pre-operative risk assessment to optimize care in high-risk frail patients.
authors: Division of Vascular Surgery, McGill University, Montreal, QC, Canada; Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, QC, Canada.
authors: L M
authors: LM
authors: Drudi
authors: Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, QC, Canada.
authors: K
authors: K
authors: Phung
authors: Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, QC, Canada.
authors: M
authors: M
authors: Ades
authors: Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, QC, Canada.
authors: J
authors: J
authors: Zuckerman
authors: Department of Medicine, McGill University, Montreal, QC, Canada.
authors: L
authors: L
authors: Mullie
authors: Division of Vascular Surgery, McGill University, Montreal, QC, Canada.
authors: O K
authors: OK
authors: Steinmetz
authors: Division of Vascular Surgery, McGill University, Montreal, QC, Canada.
authors: D I
authors: DI
authors: Obrand
authors: Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, QC, Canada; Department of Medicine, McGill University, Montreal, QC, Canada; Division of Cardiology, Jewish General Hospital, Montreal, QC, Canada. Electronic address: jonathan.afilalo@mcgill.ca.
authors: J
authors: J
authors: Afilalo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001014:Aortic Aneurysm / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D001027:Aortography / Q000379:methods*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality*; D001823:Body Composition; D000072226:Computed Tomography Angiography; D057510:Endovascular Procedures / Q000009:adverse effects / Q000401:mortality*; D005260:Female; D016330:Frail Elderly; D000073496:Frailty / Q000000981:diagnostic imaging* / Q000401:mortality / Q000503:physiopathology; D006304:Health Status; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D016658:Psoas Muscles / Q000000981:diagnostic imaging* / Q000503:physiopathology; D011792:Quebec; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D062606:Tertiary Care Centers; D013997:Time Factors; D016896:Treatment Outcome
keywords: Aneurysm; Aortic surgery; Endovascular surgery; Frailty; Psoas muscle area