Society of University Surgeons Sarcopenia is a predictor of outcomes in very elderly patients undergoing emergency surgery Yang Du, BSc, a Constantine J. Karvellas, MD, SM, FRCPC, b,c Vickie Baracos, PhD, d David C. Williams, MD, MSc, FRCSC, FACS, a and Rachel G. Khadaroo, MD, PhD, FRCSC, a,c on behalf of the Acute Care and Emergency Surgery (ACES) Group, Edmonton, Canada Background. With the increasing aging population, the number of very elderly patients (age $80 years) undergoing emergency operations is increasing. Evaluating patient-specific risk factors for postoperative morbidity and mortality in the acute care surgery setting is crucial to improving outcomes. We hypothesize that sarcopenia, a severe depletion of skeletal muscles, is a predictor of morbidity and mortality in very elderly patients undergoing emergency surgery. Methods. A total of 170 patients older than the age of 80 underwent emergency surgery between 2008 and 2010 at a tertiary care facility; 100 of these patients had abdominal computed tomography images within 30 days of the operation that were adequate for the assessment of sarcopenia. The impact of sarcopenia on the operative outcomes was evaluated using both univariate and multivariate analysis. Results. The mean patient age was 84 years, with an in-hospital mortality of 18%. Sarcopenia was present in 73% of patients. More sarcopenic patients had postoperative complications (45% sarcopenic versus 15% nonsarcopenic, P = .005) and more died in hospital (23 vs 4%, P = .037). There were no differences in duration of stay or requirement for intensive care unit postoperatively. After we controlled for confounding factors, increasing skeletal muscle index (per incremental cm 2 /m 2 ) was associated with decreased in-hospital mortality (odds ratio ;0.834, 95% confidence interval 0.731–0.952, P = .007) in multivariate analysis. Conclusion. Sarcopenia was independently predictive of greater complication rates, discharge disposition, and in-hospital mortality in the very elderly emergency surgery population. Using sarcopenia as an objective tool to identify high-risk patients would be beneficial in developing tailored preventative strategies and potentially resource allocation in the future. (Surgery 2014;156:521-7.) From the Division of General Surgery, Department of Surgery, a Division of Gastroenterology, Department of Medicine, b Division of Critical Care Medicine, c and Department of Oncology, d University of Alberta, Edmonton, Canada WITH THE INCREASING AGING POPULATION, the number of very elderly patients undergoing emergency sur- gery is increasing. Postoperative complications can result in longer hospital stays, need for intensive care, greater resource expenditure, and increased mortality. Evaluating patient-specific risk factors for postoperative morbidity and mortality in the acute care operative setting is crucial in clinical decision-making and improving outcome. To iden- tify those at greater risk of postoperative morbidity and mortality, clinicians have used grading systems such as the American Society of Anesthesiologists (ASA) classification and body mass index (BMI) with mixed success. Frailty, a lack of physiologic reserve to tolerate acute stress on the body, recently has been suggested to be a stronger predictor of operative Funded by the M.S.I. Foundation Grant #866 (to R.G.K.). The Acute Care and Emergency Surgery Group includes Drs Ro- nald Brisebois, Klaus Buttenschoen, Kamran Fathimani, Stewart M. Hamilton, Rachel G. Khadaroo, Gordon M. Lees, Todd P. W. McMullen, William Patton, Mary vanWijngaarden-Stephens, J. Drew Sutherland, Sandy L. Widder, and David C. Williams. Presented at the 9th Annual Academic Surgical Congress in San Diego, CA, February 4–6, 2014. Accepted for publication April 15, 2014. Reprint requests: Rachel G. Khadaroo, MD, PhD, FRCSC, Assis- tant Professor of Surgery, University of Alberta, 2D Walter Mack- enzie Centre, 8440-112 St. NW, Edmonton, Alberta, T6G 2B7, Canada. E-mail: khadaroo@ualberta.ca. 0039-6060/$ - see front matter Ó 2014 Mosby, Inc. All rights reserved. http://dx.doi.org/10.1016/j.surg.2014.04.027 SURGERY 521