Preoperative Sarcopenia Predicts Major Postoperative Morbidity in Patients Undergoing Pancreatic Surgery for Chronic Pancreatitis.

BACKGROUND: Sarcopenia, defined as loss of skeletal muscle mass and function, is associated with adverse outcomes in major surgery. However, its prevalence and impact on outcomes in chronic pancreatitis (CP) patients undergoing pancreatic surgeries remain unknown. METHODS: Retrospective analysis of adult CP patients undergoing non-TPIAT CP surgeries (Whipple, Puestow, Frey, or distal pancreatectomy) from 2015-2025. Patients who underwent TPIAT were excluded. Sarcopenia was defined using CT-based skeletal muscle index at L3 vertebra with validated sex-specific cutoffs. Primary outcome was major morbidity (Clavien-Dindo ≥IIIa and Comprehensive Complication Index >26.2). Secondary outcomes included specific complications, hospital stay, readmission, mortality, and one-year metabolic outcomes. RESULTS: Of 65 patients, 20 (30.8%) were sarcopenic. Sarcopenic patients had lower BMI (21.2 vs 25.1kg/m², p=0.003), though 20% had BMI ≥25kg/m². Sarcopenic patients experienced dramatically higher complication rates: any complication (85% vs 37.8%, p<0.001), major morbidity (80% vs 20%, p<0.001), and 30-day readmission (55% vs 11.1%, p<0.001). Hospital stay was longer (10 vs 7 days, p=0.004). In-hospital mortality occurred exclusively in sarcopenic patients (20% vs 0%, p=0.007). On multivariable analysis, sarcopenia is independently associated with major morbidity (adjusted odds ratio 97.6, p<0.001). One-year metabolic outcomes were comparable between groups. CONCLUSIONS: Sarcopenia affects one-third of CP patients undergoing non-TPIAT CP surgeries and is associated with increased perioperative morbidity and mortality. CT-based sarcopenia assessment should be integrated into preoperative risk stratification and surgery should be pursued only after aggressive rehabilitation.