Through analytic morphomics, we are able to quantify markers of sarcopenia and identify patients at risk for increased mortality and poor surgical outcomes. Early identification of patients offers us the opportunity to remediate sarcopenia through perioperative training and support. Participating patients spend less time in the hospital and have lower healthcare costs. This program has the potential to improve the perioperative patient experience and ease financial burdens.

We quantified reference values for lumbar and thoracic muscle CSA measures in a healthy US population. We defined the effect of IV contrast and different HU ranges for muscle. Combined, these results facilitate the extraction of clinically valuable data from the large numbers of existing scans performed for medical indications.

Morphometric age correlated with mortality after liver transplant with better discrimination than chronologic age. Assigning a morphometric age to potential liver transplant recipients could improve prediction of postoperative mortality risk.

Background Sarcopenia is associated with poor outcomes after major surgery. There are currently no data regarding the financial implications of providing care for these high-risk patients. Study Design We identified 1,593 patients within the Michigan Surgical Quality Collaborative (MSQC) who underwent elective major general/vascular surgery at a single institution between 2006–2011. Patient sarcopenia, determined by lean psoas area (LPA), was derived from preoperative CT scans using validated analytic morphomic methods. Financial data including hospital revenue and direct costs was acquired for each patient through the hospital’s finance department. Financial data was adjusted for patient and procedural factors using multiple linear regression methods and Mann-Whitney U test was employed for significance testing. Results After controlling for patient and procedural factors, decreasing LPA was independently associated with increasing payer costs ($6,989.17 per 1000mm2 LPA, p<0.001). The influence of LPA on payer costs increased to $26,988.41 per 1000mm2 decrease in LPA (p<0.001) in patients who experienced a postoperative complication. Further, the covariate adjusted hospital margin decreased by $2,620 per 1000mm2 decrease in LPA (p<0.001) such that average negative margins were observed in the third of patients with the smallest LPA. Conclusions Sarcopenia is associated with high payer costs and negative margins after major surgery. While postoperative complications are universally expensive to payers and providers, sarcopenic patients represent a uniquely costly patient demographic. Given that sarcopenia may be remediable, efforts to attenuate costs associated with major surgery should focus on targeted preoperative interventions to optimize these high risk patients for surgery.

Background A cornerstone of a surgeon’s clinical assessment of suitability for major surgery is best described as the “eyeball test”. Pre-operative imaging may provide objective measures of this subjective assessment by calculating a patient’s morphometric age. Our hypothesis is that morphometric age is a surgical risk factor distinct from chronologic age and comorbidity and correlates with surgical mortality and length of stay. Study Design This is a retrospective cohort study within a large academic medical center. Using novel analytic morphomic techniques on pre-operative CT scans, a morphometric age was assigned to a random sample of patients having inpatient general and vascular abdominal surgery during 2006–2011. The primary outcomes for this study are post-operative mortality (1-year) and length of stay (LOS). Results The study cohort (N=1370) was stratified into tertiles based on morphometric age. The postoperative risk of mortality was significantly higher in the morphometric old age group when compared to the morphometric middle age group (OR = 2.42, 95%CI: 1.52 – 3.84, p<0.001). Morphometric old age patients were predicted to have a 4.6 day longer LOS than the morphometric middle age tertile. Similar trends were appreciated when comparing morphometric middle and young age tertiles. Chronologic age correlated poorly with these outcomes. Furthermore, patients in the chronologic middle age tertile found to be of morphometric old age had significantly inferior outcomes (mortality 21.4% and mean LOS 13.8 days) compared to patients in the chronologic middle age tertile found to be of morphometric young age (mortality 4.5% and mean LOS 6.3 days, p<0.001 for both). Conclusions Preoperative imaging can be used to assign a morphometric age to patients, which accurately predicts mortality and length of stay.

BackgroundThe purpose is to investigate the clinical significance of body morphomics changes in stage III–IV oropharyngeal cancer patients during concurrent chemoradiotherapy (CRT).MethodsFifty patients who underwent CRT were selected for body composition analyses by either availability of pre/post treatment DEXA scans or a novel CT-based approach of body morphomics analysis (BMA). BMA changes (lean psoas and total psoas area) were compared to total lean body mass changes by DEXA scans using two-sample t tests. Pearson correlation was used to compare the BMA measures to head and neck specific quality of life outcomes. Cox hazards model was used to predict mortality and tumor recurrence.ResultsClinically significant declines in total psoas area and lean body mass of similar magnitude were observed in both BMA and DEXA cohorts after CRT. Loss of psoas area (P < 0.05) was associated with greater frailty and mobility issues (3 out of 15 UWQOL domains). Total psoas area is more sensitive for local recurrence than weight changes and T-stage on multivariate analyses.ConclusionsBMA specifically evaluating psoas area appears to correlate with head and neck cancer quality of life physical domains. Pre- and post-treatment total psoas area at L4 appears prognostic for tumor recurrence.

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Background-Sarcopenia is associated with poor outcomes after major surgery. There are currently no data regarding the financial implications of providing care for these high-risk patients.