Aim Frailty assessment in elderly patients is crucial to predict the postoperative course, considering that frailty is highly associated with postoperative complications and mortality. The aim of this study was to evaluate the value of osteopenia as a risk factor for severe postoperative complications in elderly patients who underwent emergency gastrointestinal surgery. Methods This study comprised 103 elderly patients who underwent emergency gastrointestinal surgery. Osteopenia was diagnosed by measuring bone mineral density, which was calculated as the average pixel density in the midvertebral core at the 11th thoracic vertebra on the preoperative plain computed tomography image. We retrospectively investigated the relationship between preoperative osteopenia and severe postoperative complications (Clavien–Dindo classification ≥III). Univariate and multivariate analyses were performed to evaluate the risk factors for severe postoperative complications. Results Twenty‐three patients (22.3%) developed severe postoperative complications. The optimal cutoff value of bone mineral density for severe postoperative complications was 119.5 Hounsfield unit (HU) and 39 patients (37.9%) were diagnosed with osteopenia. The univariate analysis revealed that the American Society of Anesthesiologists Physical Status of ≥3 (P = .0084), hemoglobin levels (P = .0026), albumin levels (P < .001), sarcopenia (P = .015), and osteopenia (P < .001) were significantly associated with severe postoperative complications. The multivariate analysis showed that osteopenia (P = .014) was an independent risk factor for severe postoperative complications. Conclusion Osteopenia may be a risk factor for severe postoperative complications in elderly patients after emergency gastrointestinal surgery.

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Osteopenia and sarcopenia, features of the aging process, are recognized as major health problems in an aging society. This study investigated the prognostic impact of osteosarcopenia, the coexistence of osteopenia and sarcopenia, in older adults undergoing curative resection for colorectal cancer. MethodsWe retrospectively reviewed data of older adults aged 65-98 years who had undergone curative resection for colorectal cancer. Osteopenia was evaluated by bone mineral density measurement in the midvertebral core of the 11th thoracic vertebra on preoperative computed tomography images.Sarcopenia was evaluated by measuring the skeletal muscle cross-sectional area at the third lumbar vertebra level. Osteosarcopenia was de ned as the coexistence of osteopenia and sarcopenia. We explored the relationship of preoperative osteosarcopenia with the disease-free and overall survival after curative resection. ResultsAmong the 325 patients included, osteosarcopenia had signi cantly lower overall survival rates than those with osteopenia (P<0.01) or sarcopenia alone (P=0.036). In the multivariate analysis, male sex (P=0.045), C-reactive protein-to-albumin ratio (P<0.01), osteosarcopenia (P<0.01), pathological T4 stage (P=0.023), and pathological N1/N2 stage (P<0.01) were independent predictors of disease-free survival, while age (P<0.01), male sex (P=0.049), C-reactive protein-to-albumin ratio (P<0.01), osteosarcopenia (P<0.01), pathological T4 stage (P=0.036), pathological N1/N2 stage (P<0.01), and carbohydrate antigen 19-9 (P=0.041) were independent predictors of overall survival. ConclusionsOsteosarcopenia was a strong predictor of poor outcomes in older adults undergoing curative resection for colorectal cancer, suggesting an important role of osteosarcopenia in an aging society.

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