İntertrokanterik Femur Kırığı Nedeniyle Cerrahi Uygulanan Yaşlı Hastalarda Psoas İndeksinin Prognostik Değeri: Retrospektif Kohort Çalışması

Abstract

Amaç: Bu çalışmada, intertrokanterik femur kırığı nedeniyle cerrahi uygulanan yaşlı hastalarda, psoas kas indeksi ile değerlendirilen preoperatif sarkopeninin postoperatif sonuçlar üzerindeki etkisi araştırıldı.

Gereç ve Yöntemler: Ocak 2018–Ağustos 2024 tarihleri arasında opere edilen toplam 142 hasta retrospektif olarak incelendi. Preoperatif bilgisayarlı tomografi görüntülerinde L3 vertebra düzeyinden psoas kas alanı ölçüldü ve boyun karesine bölünerek psoas kas indeksi hesaplandı. Sarkopeni, psoas indeksi <2,45 cm²/m² olarak tanımlandı. Hastalar sarkopenik (n=62) ve sarkopenik olmayan (n=80) olmak üzere iki gruba ayrıldı; perioperatif sonuçlar, komplikasyonlar, yoğun bakım yatışı, hastanede kalış süresi, mobilizasyon zamanı ve mortalite açısından karşılaştırıldı.

Bulgular: Sarkopenik hastalar daha yaşlıydı ve daha düşük BKİ ile albümin düzeylerine sahipti (tümü p<0,001). Sarkopenik grupta komplikasyon oranı daha yüksek (38,7% vs. 17,5%, p=0,008), hastanede kalış süresi daha uzun (9,9 ± 3,6 vs. 7,6 ± 3,0 gün, p<0,001), yoğun bakım yatış oranı daha fazla (29,0% vs. 13,8%, p=0,028) ve bir yıllık mortalite oranı daha yüksekti (29,0% vs. 11,3%, p=0,011). Düşük psoas indeksi, ileri yaş, ASA ≥III, yoğun bakım yatışı ve postoperatif komplikasyonlar bir yıllık mortalitenin bağımsız öngördürücüleri olarak belirlendi.

Sonuç: Düşük psoas indeksi, intertrokanterik femur kırığı nedeniyle cerrahi uygulanan yaşlı hastalarda artmış postoperatif komplikasyon, uzamış hastane yatışı, daha yüksek yoğun bakım gereksinimi ve artmış bir yıllık mortalite ile anlamlı şekilde ilişkili bulundu. Bu bulgular, BT temelli psoas kas kütlesi değerlendirmesinin perioperatif riski yüksek kırılgan hastaların belirlenmesinde basit, objektif ve klinik açıdan yararlı bir belirteç olabileceğini göstermektedir. Psoas indeksinin preoperatif değerlendirmeye dahil edilmesi, risk sınıflamasının iyileştirilmesine, perioperatif planlamanın güçlendirilmesine ve bireyselleştirilmiş postoperatif bakım stratejilerinin geliştirilmesine katkı sağlayabilir.

Keywords

• Sarkopeni
• kalça kırıkları
• psoas kası
• prognoz
• tomografi

Prognostic Value of the Psoas Index in Elderly Patients Undergoing Surgery for Intertrochanteric Femoral Fractures: A Retrospective Cohort Study

Abstract

Aim: This study evaluated the effect of preoperative sarcopenia, assessed by psoas muscle index, on postoperative outcomes in elderly patients undergoing surgery for intertrochanteric femoral fractures.

Material and Methods: A total of 142 patients operated between January 2018 and August 2024 were retrospectively analyzed. Psoas muscle area was measured at the L3 level on preoperative CT scans and normalized to height squared. Sarcopenia was defined as a psoas index <2.45 cm²/m². Patients were divided into sarcopenic (n=62) and non-sarcopenic (n=80) groups, and perioperative outcomes, complications, ICU admission, length of stay, ambulation time, and mortality were compared.

Results: Sarcopenic patients were older and had lower BMI and albumin levels (all p<0.001). They had higher complication rates (38.7% vs. 17.5%, p=0.008), longer hospitalization (9.9 ± 3.6 vs. 7.6 ± 3.0 days, p<0.001), higher ICU admission (29.0% vs. 13.8%, p=0.028), and increased one-year mortality (29.0% vs. 11.3%, p=0.011). Low psoas index, advanced age, ASA ≥III, ICU admission, and postoperative complications independently predicted one-year mortality.

Conclusion: Low psoas index was significantly associated with increased postoperative complications, prolonged hospitalization, higher ICU admission, and greater one-year mortality in elderly patients undergoing surgery for intertrochanteric femoral fractures. These findings suggest that CT-based assessment of psoas muscle mass may provide a simple, objective, and clinically useful marker for identifying frail patients at higher perioperative risk. Incorporating psoas index into preoperative evaluation may help improve risk stratification, guide perioperative planning, and support individualized postoperative care in this vulnerable patient population.

Keywords

• Sarcopenia
• hip fractures
• psoas muscle
• prognosis
• tomography

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