When Acute Physiology Prevails: The Limits of CT-Derived Body Composition in Fulminant Operative Acute Mesenteric Ischemia

Background Computed tomography–derived body composition parameters, including sarcopenia and adipose tissue distribution, have been proposed as prognostic markers in surgical patients; however, their role in AMI remains unclear. This study aimed to evaluate the association of sarcopenia, visceral adipose tissue (VAT), and subcutaneous adipose tissue (SAT) with short-term outcomes in surgically treated AMI. Methods This retrospective cohort study included consecutive adult patients who underwent surgery for AMI between 2015 and 2025 at a tertiary referral center. Preoperative CT scans were used to assess skeletal muscle index (SMI), VAT, and SAT at the third lumbar vertebra level. Sarcopenia was defined using established CT-based SMI thresholds. Visceral adipose tissue and SAT adiposity were defined as areas ≥100 cm 2 . The primary outcome was 30-day mortality, and the secondary outcome was length of hospital stay (LOS). Results Sarcopenia was present in 76.7% of patients. The 30-day mortality rate was 54.8%. Sarcopenia was not associated with 30-day mortality or LOS ( P > 0.05). Similarly, neither VAT nor SAT adiposity was associated with mortality or LOS. Patients who died within 30 days were significantly older ( P = 0.004) and had significantly lower serum albumin levels ( P = 0.008). Length of hospital stay was significantly shorter in non-survivors ( P < 0.001). Discussion Although sarcopenia and abnormal adipose tissue distribution were highly prevalent, CT-derived morphometric parameters did not independently discriminate short-term outcomes in surgically treated AMI. These findings suggest that in fulminant operative AMI, acute ischemic burden, and systemic physiologic deterioration may outweigh the prognostic contribution of baseline body composition metrics.