Pre-operative Computed Tomography-based Sarcopenia Assessment as a Predictor of Mortality and Functional Outcome following Geriatric Hip Fracture Surgery

Abstract

Abstract Introduction: Hip fractures among older adults are known to be highly morbid, lethal, and with low chances of functional improvement. Sarcopenia has been identified as an important predictor of outcomes due to its characteristics such as muscle mass depletion and quality loss. Computed tomography (CT)-based sarcopenia is currently seen as an objective and practical way to predict sarcopenia in the acute care setting. Materials and Methods: The research employed a prospective study design in which 50 subjects above the age of 60 years with hip fractures undergoing hip surgery were studied. Patients were grouped based on their sarcopenia status as defined by muscle parameters from CT such as psoas muscle area and attenuation. Patient demographics, radiological measurements, and outcome measures such as post-operative complications, length of hospitalization, mortality, and Harris Hip Scores were obtained. Results: Sarcopenic patients had significantly lower muscle mass (3.8 ± 0.9 cm2 vs. 6.5 ± 1.2 cm2) and attenuation (28 ± 5 Hounsfield Units [HU] vs. 42 ± 6 HU; P < 0.001). There were more post-operative complications (58.3% vs. 23.1%) and prolonged hospital stays (12.5 ± 3.2 days vs. 8.4 ± 2.1 days). There were more deaths in the sarcopenic group (33.3% vs. 3.8%). The functional scores were worse, as 50% of sarcopenic patients had poor Harris Hip Scores versus 15.4% of non-sarcopenic patients. Sarcopenic patients had significantly lower psoas muscle area (3.8 ± 0.9 cm2 vs. 6.5 ± 1.2 cm2; P < 0.001) and muscle attenuation (28 ± 5 HU vs. 42 ± 6 HU; P < 0.001). Conclusion: Sarcopenia identified by pre-operative CT is an excellent predictor of mortality, post-operative complications, and poor function in elderly patients with hip fractures. Regular screening for sarcopenia can assist in risk stratification and appropriate perioperative management.