Sarcopenia and Myosteatosis Predict Adverse Outcomes After Emergency Laparotomy: A Multi-Centre Observational Cohort Study

Samantha Body, Marjolein A P Ligthart, Saqib Rahman, James Ward, Peter May-Miller, Philip H Pucher, Nathan J Curtis, Malcolm A West, Clizia Airofarulla, Louise Alder, Nicholas Baylem, David Berry, Anastasia Benjafield, Thakshyanee Bhuvanakrishna, Amanda Bond, Richard Booth, Jack Broadhurst, James P Byrne, Rachel Carten, Duncan ChamblerHeather Davis, Mark R Edwards, Paul Froggatt, Nader Francis, Michael P W Grocott, Gui Han Lee, Denny Z H Levett, Camilla Hickish, Frances Howse, Prashan Kangesu, Zeeshan Khawaja, Jieyun Lee, Chui Lee, Jenny McLachlan, Stuart Mercer, Alex H Mirnezami, Brendan Moran, Victoria Morrison Jones, Kate Nicholls, Steven W M Olde Damink, Katherine Pearson, John N Primrose, Paul Robinson, Eva Sorensen, Benjamin M Stubbs, Noori Suhail, Simon Toh, Michael Terry, Alexios Tzivanakis, Timothy J Underwood, Wessex Research Collaborative

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6 Citations (Web of Science)


OBJECTIVE: To determine the relationship between body composition (BC), specifically low skeletal muscle mass (sarcopenia) and poor muscle quality (myosteatosis) and outcomes in emergency laparotomy patients.

BACKGROUND: Emergency laparotomy has one of the highest morbidity and mortality rates of all surgical interventions. BC objectively identifies patients at risk of adverse outcomes in elective cancer cohorts, however evidence is lacking in emergency surgery.

METHODS: An observational cohort study of patients undergoing emergency laparotomy at ten English hospitals was performed. BC analyses were performed at the third lumbar vertebrae level using pre-operative CT images to quantify skeletal muscle index (SMI) and skeletal muscle radiation attenuation (SM-RA). Sex-specific SMI and SM-RA were determined, with the lower tertile splits defining sarcopenia (low SMI) and myosteatosis (low SM-RA). Accuracy of mortality risk prediction, incorporating SMI and SM-RA variables into risk models was assessed with regression modelling.

RESULTS: Six hundred and ten patients were included. Sarcopenia and myosteatosis were both associated with increased risk of morbidity (52.1% vs. 45.1%, p = 0.028; 57.5% vs. 42.6%, p = 0.014), 30-day (9.5% vs. 3.6%, p = 0.010; 14.9% vs. 3.4%, p < 0.001), and 1-year mortality (27.4% vs. 11.5%, p < 0.001; 29.7% vs.12.5%, p < 0.001). Risk-adjusted 30-day mortality was significantly increased by sarcopenia (OR 2.56 (95%CI 1.12-5.84), p = 0.026) and myosteatosis (OR 4.26 (2.01-9.06), p < 0.001), similarly at 1-year (OR 2.66 (95%CI 1.57-4.52), p < 0.001; OR 2.08 (95%CI 1.26-3.41), p = 0.004). BC data increased discrimination of an existing mortality risk-prediction model (AUC 0.838, 95%CI 0.835-0.84).

CONCLUSION: Sarcopenia and myosteatosis are associated with increased adverse outcomes in emergency laparotomy patients.

Original languageEnglish
Pages (from-to)1103-1111
Number of pages9
JournalAnnals of Surgery
Issue number6
Early online date25 Feb 2021
Publication statusPublished - Jun 2022


  • emergency
  • laparotomy
  • mortality
  • myosteatosis
  • sarcopenia

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