Computerized Tomography-Derived Sarcopenia is Independently Associated With Acute Care Physical Therapy Utilization Among Patients With Renal Cell Carcinoma

Background: Sarcopenia is prevalent among patients with renal cell carcinoma (RCC) and is an independent predictor of poor survival outcomes. This study evaluated the association between preoperative radiographic sarcopenia and receipt of postoperative physical therapy (PT) in patients with RCC. Methods: Adults who underwent nephrectomy for RCC between 2009 and 2022, were referred to PT, and had available imaging within 90 days preoperatively were included. Skeletal muscle index (cm 2 /m 2 ) was calculated from computerized tomography at the L3 vertebral level. Radiographic sarcopenia was defined as skeletal muscle index <52.4 cm 2 /m 2 in males and <38.5 cm 2 /m 2 in females. Patients receiving PT were defined as having ≥1 inpatient session. Multivariable regression identified independent predictors of receiving PT after referral. Results: Among 172 referred patients, 51 (29.7%) received PT. Of 101 referred patients with sarcopenia, only 38 (37.6%) received PT. Patients receiving PT were older, had more comorbidities, slower walking speed, longer length of stay, and were more frequently sarcopenic (sarcopenic 74.5% vs 25.5% nonsarcopenic, P = .006). Independent predictors of receiving PT included open surgical approach (odds ratio [OR] 5.18, 95% confidence interval 1.52–17.68), postoperative complications (Grade 1–2 OR 2.53, P = .034; Grade ≥3 OR 6.59, P = .004), and radiographic sarcopenia (OR 2.71, 95% confidence interval 1.04–7.08, P = .042). Male sex was associated with lower odds of receiving PT (OR 0.28, P = .019). Conclusions: Radiographic sarcopenia was associated with receiving inpatient PT, though most sarcopenic patients did not receive PT. These findings reveal a gap in prioritizing at-risk patients and suggest that the integration of imaging into preoperative assessment may support perioperative rehabilitation strategies.