678 Can patients have their old life back? Using PM:L3 ratio to predict discharge destination of emergency laparotomy survivors. (12th October 2021) - Ming, J Y
Abstract: Aim: Psoas muscle:L3 vertebra (PM:L3) ratio is a relatively new risk assessment tool for emergency laparotomy (1, 2) based upon the proven concept that sarcopenia – as diagnosed by low skeletal muscle index (3–6), psoas muscle density (7–9) or total psoas area (10–13) in a single axial slice CT image – correlates with increasing risks of bad outcomes in surgery. This study looks into the association between PM:L3 ratio of emergency laparotomy patients from home and their discharge destination. Method: We performed an analysis on patients in the Hunter Emergency Laparotomy Audit (HELA) database, from January 2016 to December 2017. HELA is a retrospective review of all emergency laparotomy undertaken in a discrete area in NSW, Australia. All patients admitted from home, survived to be discharged from hospital and had an available CT abdomen were included (N = 433/562). A single slice axial CT image at the L3 endplate level was analysed using ImageJ ® software to measure the area of L3 and bilateral psoas muscles. Results: PM:L3 ratio is significantly lower in the group of patient discharged to a care facility than the group discharging back to their previous home residence (mean 0.951 vs. mean 1.128, p < 0.001). Upon further analysis, the PM:L3s are divided into quartiles and stratified by sex. There is an association between lower PM:L3 and risk of discharging into a care facility (Q1 22.45%, Q2 19.59%, Q3 19.10%, Q4 5.71%). Conclusions: PM:L3 ratio can predict the discharge destination of patients undergoing emergency laparotomy.