Association Between Computed Tomography-Derived Skeletal Muscle Index and Intraoperative Complications in Patients Undergoing Endometrial Cancer Surgery

To evaluate the association between preoperative computed tomography-derived skeletal muscle index and intraoperative complications in endometrial cancer surgery. This retrospective cohort study included 230 patients treated between 2014 and June 2023. Skeletal muscle index was calculated from a single L3 computed tomography image and normalized to height squared. Low skeletal muscle index was defined descriptively as < 41 cm²/m². Intraoperative complications were identified from operative and anesthesia records. Associations were examined using multivariable logistic regression, with additional adjustment for comorbidity in sensitivity analysis. Low skeletal muscle index was present in 95 patients (41.3%), and 25 (10.9%) experienced an intraoperative complication. Mean skeletal muscle index was lower in patients with complications than in those without complications (41.65 ± 8.13 vs. 43.76 ± 9.96 cm²/m²), but the difference was not statistically significant ( p = 0.310). Each 10 cm²/m² decrease in skeletal muscle index was not significantly associated with complications after adjustment (odds ratio 1.29, 95% confidence interval 0.82–2.02; p = 0.272). Adjustment for comorbidity did not materially change the estimate. The area under the receiver operating characteristic curve was 0.558 (95% confidence interval 0.435–0.680). Computed tomography-derived skeletal muscle index was not independently associated with intraoperative complications and had limited discriminatory ability when considered alone. It should not be interpreted as a stand-alone preoperative risk-stratification tool. Prospective studies incorporating frailty and clinical and procedural factors are needed.