Objective To investigate the employment of sarcopenia in the assessment of the surgical risk and prognosis of intertrochanteric fracture in the elderly patients. Methods A total of 96 elderly patients were included in this study, who met the inclusion criteria and attended for intertrochanteric fractures from January 2013 to April 2016. The cross-sectional skeletal muscle area (cm²) was measured at the pedicle of the 12 thoracic vertebra on the chest CT scan. The skeletal muscle index (SMI) was calculated by muscle cross-sectional area/square of height (cm²/m²). Sarcopenia was defined by SMI cut-off values at T12 level:42.6 cm²/m² for men and 30.6 cm²/m² for women. Linear regression analysis was used to explore the relationship between SMI and the length of hospital stay and volume of blood transfusion, and t-test to analyze the difference in the length of hospital stay, volume of blood transfusion, peri-operative mortality and postoperative mortality at 1 year. Results Of 96 patients, 45 were diagnosed as sarcopenia, and SMI had statistically significant effect on the blood transfusion volume (P<0.05), but not on the length of hospital stay (P<0.05). There was no statistically significant difference between patients with and without sarcopenia in the length of hospital stay and perioperative mortality (P>0.05), but there was statistically significant difference in the volume of blood transfusion and postoperative mortality at 1 year (P<0.05). The intertrochanteric fracture patients with sarcopenia needed more blood transfusion with a higher postoperative mortality at 1 year; however, there was no significant increase in the length of hospital stay and perioperative mortality. Conclusion The diagnosis of sarcopenia based on SMI may be of some significance in assessing the surgical risks and prognosis of intertrochanteric fracture in the elderly patients.