Psoas muscle density as a predictor of postoperative functional status and long-term survival in ruptured abdominal aortic aneurysm

Q: What are the key findings of this study?

Low preoperative psoas muscle density was associated with significantly lower long-term survival (p<0.01) and higher odds of postoperative ADL decline (OR 6.57; 95% CI 1.68-25.78) after rAAA repair.

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: ruptured abdominal aortic aneurysm (n=57). Intervention: Low psoas muscle density vs. High psoas muscle density. Primary outcome: long-term survival (p=<0.01).

Q: What question did this study set out to answer?

To evaluate the association between preoperative psoas muscle density and long-term survival as well as functional decline in patients undergoing emergency repair for ruptured abdominal aortic aneurysm.

Haruki Tanaka; Yuki Takagi; Toru Mikoshiba; Hajime Ichimura; Tishi Fujii; Noburo Ohashi; Yuko Wada; Tatsuichiro Seto

doi:10.1016/j.avsg.2026.03.009

March 1, 2026Annals of Vascular SurgeryOpen Access

Psoas muscle density as a predictor of postoperative functional status and long-term survival in ruptured abdominal aortic aneurysm

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Key result

Low psoas density linked to lower survival and ~557% higher ADL decline risk after rAAA repair.

P<0.01
n=57

Why the study?

Ruptured abdominal aortic aneurysm carries high mortality and functional decline, and psoas muscle density measured on preoperative CT may serve as a proxy for sarcopenia-related frailty to predict post-repair outcomes.

Does low preoperative psoas muscle density predict reduced long-term survival and postoperative ADL decline in patients undergoing emergent ruptured abdominal aortic aneurysm repair?

Key Points

To evaluate the association between preoperative psoas muscle density and long-term survival as well as functional decline in patients undergoing emergency repair for ruptured abdominal aortic aneurysm.
Included 57 patients (median age: 75 years; 60% male) undergoing emergency repair for ruptured abdominal aortic aneurysm between 2009 and 2023 in a single-center retrospective cohort study.
Assessed psoas muscle density on preoperative CT at the third lumbar vertebra using sex-specific cutoffs (males: 40.3 Hounsfield Units; females: 31.01 Hounsfield Units).
Evaluated primary long-term survival along with secondary outcomes of in-hospital mortality and postoperative activities of daily living decline defined by the Barthel Index.
Long-term survival was significantly lower in the low density group compared to the high density group (log-rank p < 0.01), with 1-year survival rates of 80% versus 92% and 5-year rates of 45% versus 77%.
Patients with low muscle density experienced more frequent postoperative decline in activities of daily living (52% [11/21] vs. 11.1% [4/36], p = 0.005) and lower discharge Barthel Index scores (58 ± 33 vs. 79 ± 31, p = 0.021).
Low preoperative psoas muscle density independently associated with increased odds of postoperative functional decline (odds ratio 6.57, 95% confidence interval 1.68–25.78, p = 0.0084).

Study Design

Type

Cohort (n=57)

Multicenter

No

Structured PICO

Does low preoperative psoas muscle density predict reduced long-term survival and postoperative ADL decline in patients undergoing emergent ruptured abdominal aortic aneurysm repair?

P

Population

57 patients undergoing emergency ruptured abdominal aortic aneurysm (rAAA) repair between 2009 and 2023, median age 75 years, 59.6% male, at a single center in Japan.

I

Intervention

Low preoperative psoas muscle density (PMD) measured on CT at the third lumbar vertebra (males: ≤40.3 HU; females: ≤31.01 HU)

C

Comparator

High preoperative psoas muscle density (PMD) (males: >40.3 HU; females: >31.01 HU)

O

Outcome

Long-term survival (all-cause death after hospital discharge)hard clinical

Main Result

p-value: p=<0.01

Limitations

Single-center, retrospective cohort design
Hardman Index might not completely reflect prognostic stratification in contemporary cohorts
Bilateral measurement was feasible in only 37% due to retroperitoneal haematomas
No universally accepted, population-specific cutoff values for PMD
Relatively small sample size
Postoperative rehabilitation protocols were not standardized

Implication

Low preoperative psoas muscle density is a practical surrogate marker for frailty that predicts reduced long-term survival and functional decline after emergent ruptured abdominal aortic aneurysm repair.

Abstract

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Discussion

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Cite This Study

Tanaka et al. (2026) conducted a cohort in ruptured abdominal aortic aneurysm (n=57). Low psoas muscle density vs. High psoas muscle density was evaluated on long-term survival (p=<0.01). Low preoperative psoas muscle density was associated with significantly lower long-term survival (p<0.01) and higher odds of postoperative ADL decline (OR 6.57; 95% CI 1.68-25.78) after rAAA repair.

synapsesocial.com/papers/69c8c195de0f0f753b39bf99 https://doi.org/10.1016/j.avsg.2026.03.009

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Psoas muscle density as a predictor of postoperative functional status and long-term survival in ruptured abdominal aortic aneurysm

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Psoas muscle density as a predictor of postoperative functional status and long-term survival in ruptured abdominal aortic aneurysm

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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