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Beyond BMI: Psoas Muscle Metrics Independently Predict Complications In Free Flap Surgery
Fiona S. Griffin, MS1, Joshua Wu, BS
1, Kelsey Van Housen, BS
2, Michael Kuharski, Jr., BS
1, Diya Sabbagh, MD
1, Reena Bhatt, MD
1, Amy Maselli, MD
1.
1Brown University, Providence, RI, USA,
2Thomas Jefferson University, Philadelphia, PA, USA.
PURPOSE: Frailty and sarcopenia are increasingly recognized as risk factors in reconstructive surgery. Traditional metrics such as body mass index (BMI) may not fully capture muscle-specific depletion. This study evaluated whether psoas muscle measurements provide independent prognostic value for outcomes after autologous reconstruction.
METHODS: A retrospective cohort of female patients undergoing autologous free tissue reconstruction (2015-2025) was analyzed. Bilateral psoas cross-sectional area at L3 was measured from preoperative CT, residualized on height, and standardized within 10-year age strata to generate z-scores. Logistic regression models assessed associations with postoperative outcomes, adjusting for BMI, smoking, and diabetes.
RESULTS: Eighty patients were included. Higher residualized psoas z-scores were independently protective against hospital complications (OR 0.49, 95% CI 0.29-0.83, p = .011), donor and flap site complications (OR 0.52, 95% CI 0.28-0.96, p = .032), and perioperative need for transfusion (OR 0.28, 95% CI 0.09-0.88, p = .024). Each 1-unit increase in residualized psoas corresponded to a 48-72% reduction in odds of these outcomes. In the 30-day postoperative period, higher psoas scores predicted lower odds of donor site necrosis (OR 0.40, 95% CI 0.18-0.91, p = .024), whereas smoking (OR 4.21, p = .043) increased necrosis risk.
CONCLUSION: Age- and size-adjusted psoas measures were independently associated with multiple postoperative complications after autologous reconstruction, underscoring their utility as frailty markers that capture risk beyond BMI.
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