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Decreased Lean Psoas Cross-Sectional Area Is Associated With Increased 1-Year All-Cause Mortality in Male Elderly Orthopaedic Trauma Patients

Touban, Basel M. MD*; Pavlesen, Sonja MD, MS*; Smoak, Jason B. MD*; Sayegh, Michael J. MD; Wang, Jiefei BS, MA; Zhao, Jiwei PhD; Anders, Mark J. MD*

Journal of Orthopaedic Trauma: January 2019 - Volume 33 - Issue 1 - p e1–e7
doi: 10.1097/BOT.0000000000001331
Original Article

Objectives: To investigate the association between lean psoas cross-sectional area (CSA) and 1-year all-cause mortality in elderly patients sustaining pelvic and long bone fractures.

Design: Retrospective cohort.

Setting: Level I trauma center.

Patients: Elderly trauma patients admitted from 2007 to 2014.

Methods: We reviewed demographic and clinical data, injury mechanism, fracture OTA/AO classification, and mortality. Axial computed tomography images were used to measure lean psoas CSA at the L3-L4 disk space. Cox proportional hazard regression analysis was used to estimate 1-year mortality association with psoas CSA in crude and adjusted for age, body mass index, Injury Severity Score, medical comorbidities, and discharge destination in total population and stratified by sex.

Main Outcome Measurement: One-year all-cause mortality defined as death within 12 months from date of hospitalization.

Results: Five hundred fifty-eight patients (54% female, 46% male) were analyzed. The pelvis was most commonly fractured (37.81%). A statistically significant association was observed between decreased lean psoas CSA and 1-year mortality in total population {hazard ratio [HR] = 0.93 [95% confidence interval (CI) = 0.90–0.96], P < 0.0001}. Stratification by gender revealed a statistically significant mortality HR in male patients [HR = 0.89 (95% CI = 0.84–0.96), P = 0.002]. We did not find a statistically significant mortality HR in female patients [HR = 0.95 (95% CI = 0.89–1.01), P = 0.103].

Conclusions: In this cohort of elderly orthopaedic trauma patients, decreased lean psoas CSA was associated with increased 1-year all-cause mortality in total population and males. Further investigation of the association of sarcopenia with mortality in the elderly is warranted.

Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

*Department of Orthopaedics, University at Buffalo, Buffalo, NY;

Department of Orthopaedics, Hofstra/Northwell School of Medicine, New Hyde Park, NY; and

Department of Biostatistics, University at Buffalo, Buffalo, NY.

Reprints: Basel M. Touban, MD, Department of Orthopaedics, University at Buffalo, 462 Grider St, Buffalo, NY 14215 (e-mail:

The research was funded by the Orthopaedic Trauma Association (OTA) resident research grant #152. The SliceOmatic software was purchased using the Orthopaedic Trauma Association resident research grant.

The authors report no conflict of interest.

Presented as poster at the Annual Meeting of the Orthopaedic Trauma Association, October 11–14, 2017, Vancouver, Canada.

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Accepted August 28, 2018

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