Sarcopenia is an indicator of preoperative frailty and a patient-specific risk factor for poor prognosis in elderly surgical patients. Some studies explored the prognostic significance of body composition (BC) parameters in relation to perioperative mortality after aortic repair and to mid and long-term survival following endovascular aneurysm repair (EVAR). The aim of the present study is to investigate the effects of several BC on short- and long-term mortality as well as on the length of hospital stay in two large cohorts of patients undergoing open surgical aortic repair (OSR) or EVAR.

Single-institution retrospective cohort study including patients who underwent EVAR or OSR from January 2010 to December 2017.All patients with a pre-operative CT scan were included in the analysis. Several parameters of BC on axial CT angiography images were analysed: skeletal muscle size (SMI), skeletal muscle area (SMA), visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT). Kaplan Meier and Cox regression analysis were performed to assess the association of BC with 1 year,long-term mortality and length of hospital stay.

A total of 250 patients treated by OSR and 227 by EVAR were included in the study, mean age of 70.8 years (OSR) and 76.3 years (EVAR). Sarcopenia was associated with a prolonged length of hospital stay in EVAR patients, but not in OSR patients (β coefficient 3.22; p-value 0.022vs0.391,p-value0.696). Sarcopenia was linked to an elevated 1 year mortality risk post-EVAR compared to those without sarcopenia (p-value 0.05).SMA and SMI were associated with a long-term mortality in EVAR patients also after adjustment for multiple confounding (HR 0.98,p-value 0.003; HR 0.97,p-value 0,032). In the cohort of OSR no significant correlation between short and long-term mortality and BC was found.

Body compostion could be predictive of increased mortality and longer hospital stay in patients undergoing EVAR. Patients with sarcopenia and pre-operative malnutrition should be critically assessed to define the indication for treatment in this cohort of elderly and morbid patients, despite EVAR procedures being less invasive.BC evaluation is an inexpensive and reproducible tool that can contribute to an improved decision-making process to detect those patients that will most profit form EVAR, ensuring a more personalized and cost-effective treatment strategy.