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Aims Sarcopenia (low muscle mass - SM) and myosteatosis (low muscle quality - SM-RA) are associated with poor outcomes after elective cancer surgery. Body composition parameters have not been explored in emergency surgery and may offer additive value to risk prediction scores. This multicentre study assessed the association of body composition and survival after emergency laparotomy. Methods A retrospective longitudinal cohort of 674 patients, across 10 hospitals in southern England were recruited (NCT03534765). All patients underwent emergency laparotomy, fulfilling NELA criteria, between August 2016 and November 2017. Pre-operative CTs were blindly analysed using L3 slices, assessing SM and SM-RA. Regression analysis was used to assess associations of body composition and 30-day mortality. Results Six hundred and ten patients were included [283(46%) men, median(IQR) age 71 years (57-79)]. P-POSSUM and NELA predicted mortality was 7% and 4.5% respectively, with a length of stay of 15 days (9-24), 30-day mortality of 7.8% and 1-year mortality of 18.9%. Significant univariate associations between 30-day mortality and age (OR1.04 (1.02-1.07);p=0.001), Charlson score (OR 6.84 (1.64-28.55);p=0.008), P-POSSUM (OR 1.03 (1.02-1.05);p&amp;lt;0.001, NELA mortality (OR 1.06 (1.04-1.08);p&amp;lt;0.001), SM (OR 0.98 (0.97-0.99);p=0.003 and SM-RA (OR 0.93 (0.9-0.96);p&amp;lt;0.001. Significant multivariate associations between 30-day mortality and NELA (OR 1.05 (1.03-1.07); p &amp;lt; 0.001, P-POSSUM (OR 1.03 (1.01-1.04); p &amp;lt; 0.001, SM-RA (OR 0.94 (0.9-0.97); p &amp;lt; 0.001. Conclusions Sarcopenia and myosteatosis are associated with increased mortality in patients undergoing emergency surgery. Body composition should be considered as an objective adjunct to traditional risk assessments, further informing the shared-decision making process around emergency surgery.

SP9.1.2 Sarcopenia and myosteatosis predict thirty-day emergency laparotomy mortality [The FrOGS study]