Giudici Simone, Lanza Ezio, Lofino Ludovica, Barison Alberto, Ammirabile Angela, Mauri Giulia, Zulian Davide, Ceolin Martina, Brocchi Andrea, Del Fabbro Daniele
Emergency and Trauma Surgery Unit, Department of General Surgery, IRCCS Humanitas Research Hospital, via Manzoni 56, 20089 Rozzano, MI, Italy.
Department of Diagnostic and Interventional Radiology, IRCCS Humanitas Research Hospital, via Manzoni 56, 20089 Rozzano, MI, Italy.
J Clin Med. 2025 Sep 20;14(18):6639. doi: 10.3390/jcm14186639.
: Emergency laparotomy (EL) is related to a high risk of morbidity and mortality. Sarcopenia (low skeletal muscle mass) and myosteatosis (poor muscle quality) have emerged as prognostic indicators in various clinical contexts. This study evaluated the impact of these conditions on postoperative outcomes in patients undergoing EL for abdominal emergencies. : A retrospective analysis was conducted on 242 patients who underwent EL between January 2016 and December 2023. Skeletal muscle index (SMI) and muscle radiation attenuation (MRA) were measured using CT imaging at the L3 level. Sarcopenia was defined as SMI ≤ 41.6 cm/m for men and ≤ 32 cm/m for women. Myosteatosis was defined as MRA ≤ 29.3 HU for men and ≤ 22 HU for women. Outcomes included 30-day mortality, hospital length of stay (h-LOS), severe complications (Clavien-Dindo ≥ 3), and Intensive Care Unit (ICU) admission. : Of the 242 patients (median age: 70; 51.2% men), 42.6% were sarcopenic and 78.1% had myosteatosis. Sarcopenia was not significantly associated with any postoperative outcomes. Conversely, myosteatosis was significantly associated with longer h-LOS (17 vs. 8 days; < 0.001), higher rates of severe complications (37.1% vs. 22.7%; = 0.048), and ICU admission (48.2% vs. 28.3%; = 0.010), but not with 30-day mortality. Multivariate analysis confirmed myosteatosis as an independent predictor of prolonged hospital stay (HR 0.59, 95% CI: 0.42-0.84 = 0.003). : Myosteatosis, rather than sarcopenia, is associated with worse postoperative outcomes following EL for abdominal emergencies. Including myosteatosis in preoperative risk assessments may improve the identification of high-risk patients and guide perioperative management.
急诊剖腹手术（EL）与高发病率和死亡率相关。肌肉减少症（骨骼肌质量低）和肌脂肪变性（肌肉质量差）已成为各种临床情况下的预后指标。本研究评估了这些情况对因腹部急症接受EL手术患者术后结局的影响。
对2016年1月至2023年12月期间接受EL手术的242例患者进行了回顾性分析。使用L3水平的CT成像测量骨骼肌指数（SMI）和肌肉辐射衰减（MRA）。肌肉减少症的定义为男性SMI≤41.6 cm/m，女性≤32 cm/m。肌脂肪变性的定义为男性MRA≤29.3 HU，女性≤22 HU。结局指标包括30天死亡率、住院时间（h-LOS）、严重并发症（Clavien-Dindo≥3级）和重症监护病房（ICU）入住情况。
在242例患者（中位年龄：70岁；51.2%为男性）中，42.6%患有肌肉减少症，78.1%患有肌脂肪变性。肌肉减少症与任何术后结局均无显著相关性。相反，肌脂肪变性与更长的h-LOS（17天对8天；<0.001）、更高的严重并发症发生率（37.1%对22.7%；=0.048）和ICU入住率（48.2%对28.3%；=0.010）显著相关，但与30天死亡率无关。多因素分析证实肌脂肪变性是延长住院时间的独立预测因素（HR 0.59，95%CI：0.42 - 0.84；=0.003）。
对于腹部急症的EL手术，肌脂肪变性而非肌肉减少症与更差的术后结局相关。将肌脂肪变性纳入术前风险评估可能会改善高危患者的识别并指导围手术期管理。
