Search Results (49)

Objective: Reducing the length of hospital stay (LOS) is a core objective in the management of acute exacerbations of chronic obstructive pulmonary disease (AECOPD). This study aimed to develop an interpretable and clinically applicable machine learning tool for predicting prolonged LOS in this population. Methods: This retrospective three-center study enrolled 1342 patients, who were randomly allocated to a training set (70%) and a test set (30%). Candidate predictors were screened using least absolute shrinkage and selection operator (LASSO) regression, and six machine learning models were developed and compared: logistic regression, random forest, gradient boosting machine, CatBoost, support vector machine, and neural network. Model discrimination was evaluated using the area under the receiver operating characteristic curve (AUC), calibration plots, and decision curve analysis. Model interpretability was achieved through SHapley Additive exPlanations (SHAP) and subgroup analyses. Results: Prolonged LOS, defined as >10 days (the median LOS in the training set), occurred in 42.0% of patients. Nine predictors were identified, including daily inhaled medication use, sputum microbiological examination, antibiotic administration, corticosteroid therapy, diuretic use, ICU admission, oxygenation index, platelet count, and neutrophil count. The random forest model demonstrated superior and consistent discriminative performance, achieving an AUC of 0.778 (95% CI: 0.748–0.807) in the training set and 0.721 (95% CI: 0.672–0.771) in the test set. SHAP analysis ranked diuretic use, daily inhaled medication use, corticosteroid therapy, sputum microbiological examination, and antibiotic administration as the five most influential features, revealing treatment-related variables associated with prolonged LOS. Subgroup analyses indicated better predictive performance in lower-risk patients (age ≤ 65 years with eGFR 1–2 stage). Conclusions: Random Forest may enable to promptly identify prolonged LOS high-risk patients, enhancing clinical vigilance and optimizing healthcare resource allocation in AECOPD patients. Full article

Background: Perioperative fluid therapy plays a critical role in the outcome of microvascular free-flap surgery. While both inadequate and excessive fluid administration may impair flap perfusion and systemic recovery, the impact of fluid balance and crystalloid volume—normalized to body weight and operative time—on postoperative complications remains underexplored. This study investigates the dose-dependent effects of intraoperative fluid and crystalloid administration on flap-related and systemic outcomes. Methods: This retrospective, single-centre cohort study included 495 adult patients who underwent microvascular free-flap transplantation between 2009 and 2020. Intraoperative fluid balance and crystalloid volumes were normalized to patient weight and operative duration (mL/kg/h) and stratified into pre-defined thresholds. The primary endpoint was the incidence of flap-related complications (partial/total flap loss, thrombosis, revision surgery). Secondary endpoints included flap loss, suture insufficiency, pneumonia, ICU length of stay (LOS-ICU), and in-hospital mortality. Results: Higher intraoperative fluid rates were significantly associated with higher complication rates. Flap-related complications occurred in 54.8% of patients receiving >10 mL/kg/h versus 37.1% in the ≤5 mL/kg/h group (p < 0.01) and reached 100% in patients receiving >20 mL/kg/h, although this category comprised only seven patients (p < 0.01). Suture insufficiency increased from 3.1% (≤5 mL/kg/h) to 57.1% (>20 mL/kg/h; p < 0.01). Pneumonia incidence rose from 8.8% (≤5 mL/kg/h) to 31.9% (>10 mL/kg/h; p < 0.01). A U-shaped trend was observed for flap loss, with the highest rate (24.6%) at >10 mL/kg/h. Crystalloid volume > 3000 mL was significantly associated with higher flap loss (20.2% vs. 0.2%; p < 0.01) and suture insufficiency (7.0% vs. 0.2%; p = 0.02). Red blood-cell (RBC) transfusions were associated with higher overall complication rates (45.6% vs. 34.2%; p < 0.01) and suture insufficiency (9.9% vs. 3.4%; p < 0.01). Gelatin-based colloids showed no negative impact. Operative time was the only strong independent predictor of total flap loss; each additional operative hour increased the odds of flap loss by 34% (p < 0.001). Intraoperative noradrenaline use and a history of neoadjuvant radiotherapy were not independently associated with flap-related complications or flap loss. Median LOS-ICU increased from 2 days to 10 days in patients receiving >20 mL/kg/h (p < 0.01). In-hospital mortality increased significantly with higher fluid volumes (0.3% for ≤10 mL/kg/h vs. 28.6% for > 20 mL/kg/h; p < 0.01). Conclusions: In 495 microvascular free-flap reconstructions, diagnosis, flap type, defect localization and operative time emerged as key determinants of postoperative outcomes, while defect type itself showed no predictive value. Intraoperative fluid overload—particularly crystalloid rates exceeding 10 mL/kg/h—is associated with a significantly higher risk of flap-related complications, pneumonia, prolonged ICU stay and mortality. These findings support the implementation of individualized or goal-directed fluid strategies in microvascular reconstructive surgery to optimize outcomes. Full article

Background: Sedative medications are widely used in intensive care units (ICUs) to facilitate patient management; however, their association with clinical outcomes remains incompletely understood. This study aimed to evaluate the association of cumulative sedative exposure with ICU length of stay (LOS) in a large cohort of critically ill adult patients. Methods: A retrospective observational study was conducted using the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. Adult ICU patients (≥18 years) with documented sedative administration were included. Total sedative exposure was quantified as the cumulative dose administered during the ICU stay. The primary outcome was ICU LOS, while the secondary outcome was in-hospital mortality. Patients were stratified into quartiles according to cumulative sedative dose. Multivariable regression analysis was performed to assess the association between total sedative exposure and ICU LOS. Results: A total of 2953 ICU stays were analyzed. Higher cumulative sedative exposure was associated with significantly prolonged ICU LOS. Mean ICU LOS increased from 68.75 h in the lowest quartile to 250.65 h in the highest quartile (p < 0.001). A weak positive correlation was observed between log-transformed total sedative dose and ICU LOS (r = 0.33, p < 0.001). In multivariable analysis, cumulative sedative exposure remained significantly associated with ICU LOS (β = 15.79, 95% CI 14.17–17.41, p < 0.001). No consistent association was identified between sedative exposure and in-hospital mortality. Conclusions: Higher cumulative sedative exposure was associated with longer ICU LOS but not with increased in-hospital mortality. These findings support the importance of carefully tailored sedation strategies in critically ill patients. However, due to the retrospective observational design, causality cannot be inferred, and residual confounding related to illness severity and treatment duration may remain. Full article

Background: Carotid endarterectomy (CEA) plays a critical role in stroke prevention, but assessing a patient’s preoperative physiological reserve remains challenging. This study aimed to evaluate the impact of sarcopenia and preoperative albumin on postoperative management outcomes and resource utilization in CEA patients with a high prevalence of metabolic comorbidities. Methods: This retrospective cohort study evaluated 67 patients who underwent elective or urgent CEA between January 2015 and June 2025. Sarcopenia was quantified using the Masseter Muscle Index (MMI) derived from routine preoperative head and neck computed tomography (CT) scans. Multivariable regression models were used to assess the relationships between the MMI, serum albumin levels, and surgical outcomes. Results: The cohort had a mean age of 66.8 years and demonstrated a significant metabolic burden, with a high prevalence of diabetes (71.6%) and an average body mass index (BMI) of 28.15 kg/m². Despite this predominantly overweight demographic, the MMI revealed underlying frailty and showed a strong inverse relationship with hospital resource utilization. A one-unit increase in the MMI significantly reduced total hospital length of stay (LOS) by 14.40 days (p = 0.001) and ICU LOS by 6.91 days (p < 0.001). Emergency surgery was the only independent predictor of mortality (OR 16.61, p = 0.047), while neither the MMI nor albumin significantly predicted short-term adverse clinical events. Conclusions: In a patient population where a higher BMI may mask underlying frailty, opportunistic screening for sarcopenia using routine preoperative CT scans provides important prognostic value. In this cohort study, a lower MMI showed an association with prolonged hospital and ICU stays; while it did not independently predict short-term mortality, its potential utility in forecasting resource utilization warrants further investigation in larger, prospective cohorts. Full article

Background/Objectives: Efficient management of intensive care unit (ICU) resources is a critical challenge for modern healthcare systems, which must balance high-quality patient care with operational and financial performance. ICU length of stay (LOS) is a key metric of clinical complexity and hospital efficiency. However, traditional methods for predicting LOS often fail to capture the complex, nonlinear interactions among physiological, demographic, and treatment-related variables. Machine learning (ML) and deep learning (DL) models have emerged as promising tools for enhancing predictive accuracy and supporting data-driven decision-making. Methods: This study presents a systematic review and meta-analysis of ML and DL approaches for predicting ICU LOS in adult patients. Following PRISMA guidelines, eight scientific databases were searched, yielding 33 eligible studies published between 2015 and 2025. Results: Mixed medical–surgical ICUs were the most common setting (51.5%), and 45.5% of datasets were sourced from public repositories. Most studies (19/33) focused on binary classification of prolonged stays, although thresholds ranged from >48 h to ≥14 days. The pooled results from ten studies yielded an AUROC of 0.9005 (95% CI: 0.8890–0.9121), indicating strong predictive capability across diverse clinical contexts. Subgroup analyses showed comparable performance between specialized surgical and general ICUs. Conclusions: These findings suggest that AI-driven LOS prediction models exhibit strong discriminatory power for ICU LOS prediction, supporting hospital capacity planning. However, to translate this into reliable clinical support, the methodological heterogeneity, scarcity of external validation, and near absence of calibration reporting identified in this review need to be addressed. Full article

Background: Sepsis remains a major global health challenge, associated with high mortality, prolonged intensive care unit (ICU) stays, and disproportionate healthcare costs. CytoSorb hemoadsorption offers a potential adjunct in septic shock, but real-world cost-effectiveness data in Diagnosis-Related Group (DRG)-based systems are limited. This study aimed to evaluate the clinical and economic impact of CytoSorb therapy in ICU patients with septic shock at a high-volume Swiss tertiary care center. Methods: A retrospective observational cohort study (2020–2023) was conducted at Kantonsspital Münsterlingen. Among 246 septic shock patients, 142 received CytoSorb therapy and 104 standard care. Patients were grouped according to treatment exposure. Baseline characteristics as well as ICU course variables, including sepsis origin, Simplified Acute Physiology Score (SAPS) II, and the Nine Equivalents of Nursing Manpower Use Score (NEMS), were compared between groups. Clinical outcomes included ICU/hospital length of stay (LOS) and duration of mechanical ventilation. Economic analysis included DRG-based revenue, direct case-related hospital costs, and net financial results. Results: CytoSorb-treated patients had significantly higher SAPS II scores at baseline. Despite higher initial acuity, this group showed a significantly shorter ICU LOS (median 408.5 vs. 554.5 h; p = 0.001), reduced hospital LOS (23.5 vs. 30.0 days; p = 0.008), and lower nursing workload (>20% NEMS point reduction; p = 0.015). Survivors treated with CytoSorb had significantly shorter ventilation durations (164.0 vs. 336.0 h; p = 0.014). Total hospital costs were not significantly different between groups; however, CytoSorb patients achieved a significantly better net financial result (CHF 17,125 vs. –1930; p = 0.025), particularly in the abdominal and pneumogenic sepsis subgroups. Conclusions: This study provides the first real-world evidence for the cost-effectiveness of CytoSorb hemoadsorption in septic shock, showing reduced ICU length of stay and improved financial outcomes, without increasing treatment costs or nursing workload. These findings challenge the perception of hemoadsorption as a cost driver and highlight its potential to optimize resource use in critical care. Further multicenter studies are needed to inform reimbursement strategies and integration into sepsis treatment protocols. Full article

Background: Length of stay (LOS) reflects healthcare utilization but may also capture patient clinical trajectories. We investigated the relationship between LOS categories, organ support requirements, and in-hospital mortality. Methods: This retrospective observational study included 1332 consecutive adult ICU patients in a tertiary-care center. ICU LOS patterns were categorized using median-based and predefined cutoffs. Multivariable logistic regression was used to identify independent predictors of in-hospital mortality. Results: Prolonged ICU LOS was associated with higher crude mortality (61.0% vs. 43.5%, p < 0.001). However, in LOS-adjusted models, mortality was independently associated with mechanical ventilation (aOR 29.89, 95% CI 17.92–49.86), inotropic support (aOR 4.94, 95% CI 3.50–6.97), hemodialysis (aOR 5.43, 95% CI 2.52–11.72), older age, and diabetes mellitus. Prolonged LOS was not independently associated with mortality (aOR 0.93, p = 0.630). Conclusions: LOS reflects underlying disease severity rather than acting as an independent driver of mortality. Integrating LOS pattern assessment with markers of organ dysfunction may improve risk stratification and resource planning in hospitalized populations. Full article

Background/Objectives: Chronic obstructive pulmonary disease (COPD) coexists with lung cancer in 40–70% of cases and increases perioperative risk, particularly in patients with severely impaired pulmonary function. Preoperative pulmonary rehabilitation (PR) has been proposed as a perioperative optimization strategy; however, its effect on hospital length of stay (LOS) in patients with advanced COPD remains unclear. This study aimed to compare postoperative complications, intensive care unit (ICU) utilization, and hospital LOS between patients with lower and higher baseline forced expiratory volume in one second (FEV1), and to evaluate the role of preoperative PR as a risk-adaptive perioperative strategy in high-risk COPD patients undergoing lung cancer surgery. Methods: This retrospective cohort study comprises patients with spirometry-confirmed COPD and non-small cell lung cancer (NSCLC) who underwent elective lung resection at a tertiary care center between March 2019 and June 2020. Disease severity was classified using the Global Initiative for Chronic Obstructive Lung Disease (GOLD) framework: GOLD 1–2 (FEV1 ≥ 50% predicted) and GOLD 3–4 (FEV1 < 50% predicted). Patients in the GOLD 3–4 group received a uniform 15-day hospital-based preoperative PR program prior to surgery. Primary outcomes were ICU stay, postoperative complications, and hospital LOS. Factors independently associated with prolonged hospital stay were examined using an exploratory multivariable linear regression model. Results: Among 63 patients (95.2% male; median age 64 years), those with GOLD 3–4 COPD had significantly lower baseline FEV1 values and longer COPD duration compared with the GOLD 1–2 group. Despite a higher perioperative risk profile, postoperative complication rates (28.6% overall; p = 0.237) and ICU utilization were comparable between groups. Median postoperative hospital LOS was significantly longer in patients with GOLD 3–4 COPD (15 [IQR 6] vs. 11 [IQR 4] days; p < 0.001). In the exploratory regression analysis, lower predicted FEV1 percent (p = 0.003) and older age were independently associated with prolonged hospital stay, whereas PR was not an independent determinant of LOS. Conclusions: In patients with lung cancer and severe COPD (GOLD 3–4) who received preoperative PR, postoperative complication rates and ICU utilization were comparable to those observed in patients with less severe disease. Prolonged hospital stay in the high-risk group was independently associated with lower FEV1 and older age, reflecting underlying disease severity. Prospective controlled studies stratified by COPD severity are needed to establish the independent contribution of preoperative PR in this population. Full article

Background: Although frailty has emerged as an important determinant of outcomes following cardiovascular surgery, the clinical significance of early postoperative physical frailty assessed during the acute recovery phase has not been investigated. Methods: We conducted a single-center retrospective observational study including patients who underwent cardiac or aortic surgery and completed a standardized physical function assessment within 10 days postoperatively. Physical frailty was defined using four objective indicators: Medical Research Council (MRC) sum score, gait speed, Timed Up and Go test, and five-times sit-to-stand test. Frailty was defined as the presence of ≥3 abnormal physical frailty indicators. Clinical outcomes included hospital length of stay (LOS) and postoperative medical complications. Negative binomial regression was used to evaluate factors associated with hospital LOS. Results: Among 441 patients included in the analysis, 308 (69.8%) were classified as frail. Frail patients were older and demonstrated significantly impaired physical performance across all frailty indicators (all p < 0.001). Frailty was associated with longer ICU stay and hospital LOS (both p < 0.001). In multivariable negative binomial regression, postoperative frailty was independently associated with prolonged hospital LOS (incidence rate ratio [IRR] 1.38, 95% CI 1.26–1.51; p < 0.001), after adjustment for age and timing of frailty assessment. Additional adjustment for surgical approach and surgical target did not improve model fit. Postoperative frailty was not significantly associated with the overall incidence of medical complications. Conclusions: Early postoperative physical frailty, assessed during the acute recovery phase, is independently associated with prolonged hospitalization after cardiac and aortic surgery. These findings suggest that early functional vulnerability captures clinically meaningful risk beyond surgical characteristics and may serve as a valuable target for postoperative risk stratification and rehabilitation planning. Full article

Background: Atrial fibrillation (AF) is common among intensive care unit (ICU) patients and is associated with increased mortality, prolonged length of stay (LOS), and greater resource utilization. Widely used AF risk scores were developed for stable outpatient populations and have limited applicability in critically ill patients. This study aimed to (1) characterize ICU patients with AF, (2) develop and temporally externally validate machine learning models to predict ICU mortality and ICU LOS, and (3) identify early clinical factors associated with these outcomes using interpretable methods. Methods: Adult ICU patients with AF from MIMIC-IV (n = 20,058) were used for model development with grouped cross-validation, and MIMIC-III (n = 11,475) served as a temporal external validation cohort. Predictors included demographics, admission characteristics, vital signs, laboratory values, vasoactive support, and AF-related medications available within the first 24 h of ICU admission. Eight classification algorithms were evaluated for ICU mortality, and six regression algorithms were evaluated for ICU LOS. Discrimination was primarily assessed using the area under the receiver operating characteristic curve (AUC) and average precision (AP), with additional threshold-dependent metrics reported to characterize operating-point behavior under low event prevalence. Probability-threshold optimization using out-of-fold predictions was applied to the primary mortality model. LOS performance was evaluated using mean absolute error (MAE), root mean squared error (RMSE), and the coefficient of determination (R²). Model interpretability was assessed using SHapley Additive exPlanations (SHAP). Results: The median age was 75 years, and ICU mortality was 8.9%. For mortality prediction, the XGBoost model demonstrated preserved discrimination on temporal external validation (MIMIC-III) (AUC = 0.743; AP = 0.226). At the default probability threshold (0.50), recall and F1 scores were low due to low event prevalence; applying a prespecified F1-optimized threshold derived from the development cohort improved sensitivity while maintaining overall discrimination. For ICU LOS, models explained little variance on temporal validation; LightGBM performed best, but the explained variance was low (MAE = 88.9 h; RMSE = 163.9 h; R² = 0.038), indicating that the first 24-h structured data provide an insufficient signal to accurately predict ICU LOS, likely due to downstream clinical and operational factors. SHAP analysis identified clinically plausible predictors of mortality and prolonged ICU stay, including reduced urine output, renal dysfunction, metabolic derangement, hypoxemia, early vasopressor use, advanced age, and admission pathways. Full article

Background/Objectives: Reasons for long-term stays in intensive care units (ICUs) include various critical conditions, prolonged weaning with post-extubation dysphagia (PED), as well as the mere presence of a tracheal cannula. In an interprofessional QM project, medicine, nursing, physiotherapy, speech and language therapy (SLT), and occupational therapy work together to reduce the length of stay (LOS) in ICUs. SLT focuses on tracheal cannula management (TCM) and PED. The primary aim of SLT is fast and safe decannulation and thereby the reduction in LOS. Methods: Two SOPs for dealing with PED patients and for structured TCM were developed for this purpose and were both implemented in a postoperative ICU, together with a SLT staff increase. To compare the effects on the intervention group (IG, n = 54), a historical control (HC, n = 58) group was created through a retrospective data analysis. We screened all patients from ICU (n = 5605), including those with tracheostomy, and analyzed them during their ICU stay. Results: Clinically relevant results were observed for the mean time in days of tracheostomy in those who could be decannulated (HC = 43.43, IG = 23.8; d = 0.99) and, even more importantly, for LOS in days (HC = 33.41, IG = 23.8; d = 0.48). Conclusions: The integration of SLT in ICU care is feasible and helps to reduce the time to decannulation and LOS. Full article

Background: Nutritional support in patients receiving extracorporeal membrane oxygenation (ECMO) is a clinical challenge. Hemodynamic instability and concerns about gut perfusion delay enteral nutrition (EN), resulting in frequent use of total parenteral nutrition (TPN). This study aimed to compare nutritional practices in patients on venoarterial (VA) vs. venovenous (VV) ECMO, and to evaluate the associations between prolonged TPN use, feeding status, circuit change frequency, length of stay, and survival. Methods: Retrospective cohort study of ECMO patients in a quaternary pediatric intensive care unit. Nutritional variables included route and amount of nutrition delivery. The primary outcome was the nutrition type (enteral vs. parenteral) in association with ECMO mode (VV vs. VA). Secondary outcomes included associations between nutrition variables (TPN by Day 14, lack of EN by Day 5 or 7) and circuit changes, ECMO duration, ICU/hospital length of stay (LOS), and mortality. Analyses by Mann–Whitney and chi-square tests. Multivariable Poisson regression was used to identify independent predictors of circuit change frequency. Results: Patients on VV ECMO achieved higher enteral intake than those on VA ECMO. Persistent need for TPN by Day 14 was associated with longer PICU LOS, hospital LOS, and ECMO duration and was independently associated with 71% higher circuit change frequency. Survival did not differ significantly by TPN duration or early EN exposure. Conclusions: VV ECMO patients received higher enteral nutrition. Persistent need for TPN by day 14 was associated with worse outcomes. These findings underscore the need for standardized, evidence-based feeding strategies in this population. Full article

Early risk prediction is essential for hospitalized prostate cancer (PCa) patients, who face acute events, such as mortality, ICU transfer, AKI (acute kidney injury), ED30 (unplanned 30-day Emergency Department revisit), and prolonged LOS (length of stay). We developed an MMoE (Multitask Mixture-of-Experts) model that jointly predicts these outcomes from the features of the multimodal EHR (Electronic Health Records) in MIMIC-IV (3956 admissions; 2497 patients). A configuration with six experts delivered consistent gains over strong single-task baselines. On the held-out test set, the MMoE improved rare-event detection (mortality AUPRC (Area Under the Precision-Recall Curve) of $0.163$ vs. $0.091$, $+79\%$) and modestly boosted ED30 discrimination (AUROC (Area Under the Receiver Operating Characteristic Curve) $\approx 0.66$ with leakage-safe ClinicalBERT fusion) while maintaining competitive ICU and AKI performance. Expert-routing diagnostics (top-1 shares, entropy, and task-dead counts) revealed clinically coherent specialization (e.g., renal signals for AKI), supporting interpretability. An efficiency log showed that the model is compact and deployable (∼85 k parameters, $0.34$ MB; $0.027$ s/sample); it replaced five single-task predictors with a single forward pass. Overall, the MMoE offered a practical balance of accuracy, calibrated probabilities, and readable routing for the prognostic layer of digital-twin pipelines in oncology. Full article

Background/Objectives: Pediatric infectious-disease admissions are common but heterogeneous. We characterized clinical, microbiological, and therapeutic patterns and identified high-risk subgroups relevant to antimicrobial stewardship. Methods: In an observational cohort of 136 children stratified by age, we recorded symptoms, diagnoses, culture results, pathogens, antibiotic therapy, and outcomes. A composite risk score integrating age and clinical/microbiological parameters was assessed. Results: Outcomes were generally favorable: intensive care unit (ICU) transfer 8.8% (95% confidence interval [CI]: 4.6–15.1), mortality 0.7% (95% CI: 0.1–3.9), and median length of stay (LOS) 10 days (interquartile range [IQR] 8–12). Pneumonia was the leading diagnosis (44.9%; 95% CI: 36.3–53.6). Among isolates, Escherichia coli (47.1%) and Klebsiella species (spp.) (27.9%) predominated. Pneumonia correlated with prolonged LOS (p = 0.006), and gastroenteritis with ICU transfer (p = 0.038) and longer LOS (p = 0.018). Mixed E. coli + Klebsiella infections were linked to prolonged stay (p = 0.021). The composite score identified a high-risk stratum with higher ICU transfer (p = 0.004) and prolonged stay (p = 0.006). Conclusions: Although overall outcomes were favorable, risk was not uniform. An age-stratified, multifactorial assessment—integrating clinical presentation, microbiology, and a composite score—identified pediatric subgroups with worse prognoses, supporting targeted monitoring and stewardship-aligned, age-aware empiric therapy. External validation is warranted. Full article

Background: Emergency laparotomy (EL) is related to a high risk of morbidity and mortality. Sarcopenia (low skeletal muscle mass) and myosteatosis (poor muscle quality) have emerged as prognostic indicators in various clinical contexts. This study evaluated the impact of these conditions on postoperative outcomes in patients undergoing EL for abdominal emergencies. Methods: A retrospective analysis was conducted on 242 patients who underwent EL between January 2016 and December 2023. Skeletal muscle index (SMI) and muscle radiation attenuation (MRA) were measured using CT imaging at the L3 level. Sarcopenia was defined as SMI ≤ 41.6 cm²/m² for men and ≤ 32 cm²/m² for women. Myosteatosis was defined as MRA ≤ 29.3 HU for men and ≤ 22 HU for women. Outcomes included 30-day mortality, hospital length of stay (h-LOS), severe complications (Clavien-Dindo ≥ 3), and Intensive Care Unit (ICU) admission. Results: Of the 242 patients (median age: 70; 51.2% men), 42.6% were sarcopenic and 78.1% had myosteatosis. Sarcopenia was not significantly associated with any postoperative outcomes. Conversely, myosteatosis was significantly associated with longer h-LOS (17 vs. 8 days; p < 0.001), higher rates of severe complications (37.1% vs. 22.7%; p = 0.048), and ICU admission (48.2% vs. 28.3%; p = 0.010), but not with 30-day mortality. Multivariate analysis confirmed myosteatosis as an independent predictor of prolonged hospital stay (HR 0.59, 95% CI: 0.42–0.84 p = 0.003). Conclusions: Myosteatosis, rather than sarcopenia, is associated with worse postoperative outcomes following EL for abdominal emergencies. Including myosteatosis in preoperative risk assessments may improve the identification of high-risk patients and guide perioperative management. Full article