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Intensive Care Unit Cognitive Disorders / Electrolyte and Hormonal Disorders · Journal article
Perioperative Medicine · September 6, 2026
Encouraging direction, but not yet definitive.
This prospective cohort study of 270 older adults undergoing hip arthroplasty reports that sarcopenia (defined by CT-based skeletal muscle index) is associated with postoperative delirium, with risk substantially increased when sarcopenia coexists with visceral obesity, but visceral obesity alone does not significantly increase risk. The findings are based on a single-centre unblinded design using a non-standard sarcopenia definition and require replication in independent cohorts.
Prospective cohort study. Older adults undergoing total hip arthroplasty; 270 patients enrolled from a single centre in China.. Intervention: Sarcopenia (operationally defined as low skeletal muscle mass by CT-based SMI) and/or visceral obesity (assessed by waist circumference). Compared with: Normal skeletal muscle mass and normal visceral obesity status (Group D as reference). n = 270. China (single centre).
Postoperative delirium prevalence: 64.70% in sarcopenia alone (Group A), 20.37% in visceral obesity alone (Group B), 73.10% in both conditions (Group C), and 24.05% in normal controls (Group D), P < 0.001 Sarcopenia alone significantly increased POD risk: OR 5.867 (95% CI 2.779–12.386) Sarcopenia with visceral obesity markedly increased POD risk: OR 9.585 (95% CI 3.923–23.418)
Safety was not reported in the material analysed. Check the source before drawing any conclusion about harm.
These findings suggest that screening for sarcopenia using CT-based skeletal muscle index may help identify older surgical patients at high risk of postoperative delirium, particularly when combined with visceral obesity assessment. However, the non-standard sarcopenia definition and single-centre design warrant validation before incorporation into routine perioperative risk stratification.
A prospective cohort study with clear methodology and meaningful effect sizes in a clinically relevant population, but limited by single-centre design, lack of blinding, and reliance on a non-standard sarcopenia definition that requires external validation.
As stated by the source record.
Quoted from the source exactly as published.
These findings suggest that screening for sarcopenia using CT-based skeletal muscle index may help identify older surgical patients at high risk of postoperative delirium, particularly when combined with visceral obesity assessment. However, the non-standard sarcopenia definition and single-centre design warrant validation before incorporation into routine perioperative risk stratification.
Graded across the dimensions that decide whether you should act, each from what the source actually supports. There is no single score, and where a dimension was not assessed it says so.
Sarcopenia (operationally defined as low skeletal muscle mass) and visceral obesity are both metabolic disorders associated with cognitive decline. Understanding the outcomes of these combined conditions is crucial. This study aimed to investigate how sarcopenia, measured by skeletal muscle index (SMI), and visceral obesity influence the occurrence of postoperative delirium (POD) in older adults. This was a prospective cohort study. A total of 270 patients undergoing total hip arthroplasty (THA) were enrolled. Sarcopenia was operationally defined as low skeletal muscle mass quantified by CT-based SMI, rather than the full EWGSOP2 definition. Visceral obesity was assessed by waist circumference (WC). POD was identified through the confusion assessment method (CAM). Receiver operating characteristic (ROC) curve analysis and the Youden index were used to calculate SMI thresholds for predicting POD. Participants were classified as follows: Group A: sarcopenia alone; Group B: visceral obesity alone; Group C: both sarcopenia and visceral obesity; and Group D: normal. We employed multivariate logistic regression model to estimate the correlation between sarcopenia, visceral obesity, and POD. A total of 270 patients were included. ROC analysis and the Youden index identified sex-specific SMI thresholds: < 29.55 cm 2 /m 2 for males and < 23.62 cm 2 /m 2 for females, optimizing SMI’s predictive accuracy for POD. The prevalence of POD was 64.70% in Group A, 20.37% in Group B, 73.10% in Group C and 24.05% in Group D, with significant differences among groups ( P < 0.001). In the multivariate logistic regression analysis, sarcopenia alone (odds ratio [OR] 5.867, 95% confidence interval [CI] 2.779–12.386) and sarcopenia with visceral obesity (OR 9.585, 95% CI 3.923–23.418) were significantly associated with an increased risk of POD compared to normal patients. Among these, individuals with both sarcopenia and visceral obesity exhibited a markedly higher risk. In contrast, visceral obesity alone was not significantly associated with POD (OR 0.821, 95% CI 0.318–2.122). Sarcopenia, as operationally defined by CT-based SMI in this study, is a risk factor for POD in older adults, and this risk is markedly amplified when it coexists with visceral obesity. However, visceral obesity alone does not significantly affect the risk of POD. China Clinical Trial Registry at https://www.chictr.org.cn/, registration number: ChiCTR2500100801, registration date: April 15, 2025.
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