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Frailty and sarcopenia do not predict adverse events in an elderly population undergoing non-complex primary elective surgery for degenerative conditions of the lumbar spine.
Spine J. 2018 02; 18(2):245-254.SJ

Abstract

BACKGROUND CONTEXT

Sarcopenia measured by normalized total psoas area (NTPA) has been shown to predict mortality and adverse events (AEs) in numerous surgical populations. The relationship between sarcopenia and postoperative outcomes after surgery for degenerative spine disease (DSD) has not been investigated.

PURPOSE

This study aimed to determine the relationships between sarcopenia, frailty, and postoperative AEs in the elderly DSD population. Secondary objectives were to describe the distribution and predictors of NTPA and to determine the relationship between sarcopenia, frailty, and length of stay, discharge to a facility, and in-hospital mortality.

STUDY DESIGN

This is an ambispective study from a quaternary care academic center.

PATIENT SAMPLE

A total of 102 patients over 65 years old who underwent elective thoracolumbar surgery for DSD between 2009 and 2013 were included in this study.

OUTCOME MEASURES

The primary outcome was a composite of perioperative AEs; the secondary outcomes were length of stay, discharge disposition, and in-hospital mortality.

METHODS

Total psoas area (TPA) at mid-L3 level on preoperative computed tomography scan adjusted for height (NTPA) defined sarcopenia. The modified frailty index (mFI) of 11 clinical variables defined frailty. The distribution and predictors of sarcopenia (NTPA) were determined. The association of NTPA with AEs, length of stay, discharge disposition to care facility, and mortality was analyzed, including adjusting for known and suspected confounders using multivariate regression.

RESULTS

Median Spine Surgical Invasiveness Index was 8 (interquartile range 2-10), and mean NTPA was 674 mm2/m2 (293.21-1636.25). Using the mFI, 20.6% were pre-frail and 19.6% were frail. Inter- and intraobserver reliability for determining NTPA were near perfect with kappa 0.95-0.97 and 0.94-1.00, respectively. The NTPA was independently associated with patient gender and body mass index (BMI) but not frailty (mFI). Age, BMI, mFI, and American Anesthesiologists' Society score were not associated with incidence of postoperative AEs. The NTPA did not predict the occurrence of AE (odds ratio [OR] 1.06 per 100 mm2/m2, 95% confidence interval [CI] 0.91-1.23, p=.45). Similarly, NTPA was not predictive of length of stay (rho=-0.04, p=.67), discharge home (OR 0.95 (95% CI 0.76-1.20) per 100 mm2/m2, p=.70), or death (OR 1.12 (95% CI 0.83-1.53) per 100 mm2/m2, p=.47). In contrast, increasing mFI was associated with increased risk of mortality (OR 3.12 (95% CI 1.21-8.03) per 0.1 increase in frailty score, p=.006).

CONCLUSIONS

In contrast to other surgical groups, sarcopenia (NTPA) or frailty (mFI) did not predict acute care complications in a selected population of elderly patients undergoing simple lumbar spine surgery for DSD. Although NTPA can be reliably measured in this population, it may be an inappropriate surrogate for sarcopenia given its anatomical relationship to spinal function.

Authors+Show Affiliations

Department of Orthopedic Surgery, Laval University, 1401 18e rue, Local B-2408, Québec, QC G1J 1Z4, Canada. Electronic address: raphaele.charest-morin.1@ulaval.ca.Combined Neurosurgical and Orthopedic Spine Program, Department of Orthopedic Surgery, University of British Columbia, Blusson Spinal Cord Centre, 6th Floor, 818 West 10th Ave, Vancouver, BC V5Z 1M9, Canada.Centre for Hip Health and Mobility, Department of Orthopedic Surgery, University of British Columbia, 466-2635 Laurel St, Vancouver, BC V5Z 1M9, Canada.Department of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC V6T 1Z3, Canada.Combined Neurosurgical and Orthopedic Spine Program, Department of Orthopedic Surgery, University of British Columbia, Blusson Spinal Cord Centre, 6th Floor, 818 West 10th Ave, Vancouver, BC V5Z 1M9, Canada.Combined Neurosurgical and Orthopedic Spine Program, Department of Orthopedic Surgery, University of British Columbia, Blusson Spinal Cord Centre, 6th Floor, 818 West 10th Ave, Vancouver, BC V5Z 1M9, Canada.Combined Neurosurgical and Orthopedic Spine Program, Department of Orthopedic Surgery, University of British Columbia, Blusson Spinal Cord Centre, 6th Floor, 818 West 10th Ave, Vancouver, BC V5Z 1M9, Canada.Combined Neurosurgical and Orthopedic Spine Program, Department of Orthopedic Surgery, University of British Columbia, Blusson Spinal Cord Centre, 6th Floor, 818 West 10th Ave, Vancouver, BC V5Z 1M9, Canada.Combined Neurosurgical and Orthopedic Spine Program, Department of Orthopedic Surgery, University of British Columbia, Blusson Spinal Cord Centre, 6th Floor, 818 West 10th Ave, Vancouver, BC V5Z 1M9, Canada.Division of Neurosurgery, Department of Surgery, Centre Universitaire Hospitalier de Sherbrooke, 3001, 12th Ave North, Local 5110, Sherbrooke, QC J1H 5N4, Canada.Combined Neurosurgical and Orthopedic Spine Program, Department of Orthopedic Surgery, University of British Columbia, Blusson Spinal Cord Centre, 6th Floor, 818 West 10th Ave, Vancouver, BC V5Z 1M9, Canada.Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver General Hospital, Room 2449 JPP 899 West 12th Ave, Vancouver, BC V5Z 1M9, Canada.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28709946

Citation

Charest-Morin, Raphaële, et al. "Frailty and Sarcopenia Do Not Predict Adverse Events in an Elderly Population Undergoing Non-complex Primary Elective Surgery for Degenerative Conditions of the Lumbar Spine." The Spine Journal : Official Journal of the North American Spine Society, vol. 18, no. 2, 2018, pp. 245-254.
Charest-Morin R, Street J, Zhang H, et al. Frailty and sarcopenia do not predict adverse events in an elderly population undergoing non-complex primary elective surgery for degenerative conditions of the lumbar spine. Spine J. 2018;18(2):245-254.
Charest-Morin, R., Street, J., Zhang, H., Roughead, T., Ailon, T., Boyd, M., Dvorak, M., Kwon, B., Paquette, S., Dea, N., Fisher, C. G., & Flexman, A. M. (2018). Frailty and sarcopenia do not predict adverse events in an elderly population undergoing non-complex primary elective surgery for degenerative conditions of the lumbar spine. The Spine Journal : Official Journal of the North American Spine Society, 18(2), 245-254. https://doi.org/10.1016/j.spinee.2017.07.003
Charest-Morin R, et al. Frailty and Sarcopenia Do Not Predict Adverse Events in an Elderly Population Undergoing Non-complex Primary Elective Surgery for Degenerative Conditions of the Lumbar Spine. Spine J. 2018;18(2):245-254. PubMed PMID: 28709946.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Frailty and sarcopenia do not predict adverse events in an elderly population undergoing non-complex primary elective surgery for degenerative conditions of the lumbar spine. AU - Charest-Morin,Raphaële, AU - Street,John, AU - Zhang,Honglin, AU - Roughead,Taren, AU - Ailon,Tamir, AU - Boyd,Michael, AU - Dvorak,Marcel, AU - Kwon,Brian, AU - Paquette,Scott, AU - Dea,Nicolas, AU - Fisher,Charles G, AU - Flexman,Alana M, Y1 - 2017/07/12/ PY - 2017/03/24/received PY - 2017/05/31/revised PY - 2017/07/06/accepted PY - 2017/7/16/pubmed PY - 2018/11/22/medline PY - 2017/7/16/entrez KW - Adverse event KW - Complication KW - Frailty KW - Modified frailty index KW - Sarcopenia KW - Spine KW - Total psoas muscle area SP - 245 EP - 254 JF - The spine journal : official journal of the North American Spine Society JO - Spine J VL - 18 IS - 2 N2 - BACKGROUND CONTEXT: Sarcopenia measured by normalized total psoas area (NTPA) has been shown to predict mortality and adverse events (AEs) in numerous surgical populations. The relationship between sarcopenia and postoperative outcomes after surgery for degenerative spine disease (DSD) has not been investigated. PURPOSE: This study aimed to determine the relationships between sarcopenia, frailty, and postoperative AEs in the elderly DSD population. Secondary objectives were to describe the distribution and predictors of NTPA and to determine the relationship between sarcopenia, frailty, and length of stay, discharge to a facility, and in-hospital mortality. STUDY DESIGN: This is an ambispective study from a quaternary care academic center. PATIENT SAMPLE: A total of 102 patients over 65 years old who underwent elective thoracolumbar surgery for DSD between 2009 and 2013 were included in this study. OUTCOME MEASURES: The primary outcome was a composite of perioperative AEs; the secondary outcomes were length of stay, discharge disposition, and in-hospital mortality. METHODS: Total psoas area (TPA) at mid-L3 level on preoperative computed tomography scan adjusted for height (NTPA) defined sarcopenia. The modified frailty index (mFI) of 11 clinical variables defined frailty. The distribution and predictors of sarcopenia (NTPA) were determined. The association of NTPA with AEs, length of stay, discharge disposition to care facility, and mortality was analyzed, including adjusting for known and suspected confounders using multivariate regression. RESULTS: Median Spine Surgical Invasiveness Index was 8 (interquartile range 2-10), and mean NTPA was 674 mm2/m2 (293.21-1636.25). Using the mFI, 20.6% were pre-frail and 19.6% were frail. Inter- and intraobserver reliability for determining NTPA were near perfect with kappa 0.95-0.97 and 0.94-1.00, respectively. The NTPA was independently associated with patient gender and body mass index (BMI) but not frailty (mFI). Age, BMI, mFI, and American Anesthesiologists' Society score were not associated with incidence of postoperative AEs. The NTPA did not predict the occurrence of AE (odds ratio [OR] 1.06 per 100 mm2/m2, 95% confidence interval [CI] 0.91-1.23, p=.45). Similarly, NTPA was not predictive of length of stay (rho=-0.04, p=.67), discharge home (OR 0.95 (95% CI 0.76-1.20) per 100 mm2/m2, p=.70), or death (OR 1.12 (95% CI 0.83-1.53) per 100 mm2/m2, p=.47). In contrast, increasing mFI was associated with increased risk of mortality (OR 3.12 (95% CI 1.21-8.03) per 0.1 increase in frailty score, p=.006). CONCLUSIONS: In contrast to other surgical groups, sarcopenia (NTPA) or frailty (mFI) did not predict acute care complications in a selected population of elderly patients undergoing simple lumbar spine surgery for DSD. Although NTPA can be reliably measured in this population, it may be an inappropriate surrogate for sarcopenia given its anatomical relationship to spinal function. SN - 1878-1632 UR - https://www.unboundmedicine.com/medline/citation/28709946/Frailty_and_sarcopenia_do_not_predict_adverse_events_in_an_elderly_population_undergoing_non_complex_primary_elective_surgery_for_degenerative_conditions_of_the_lumbar_spine_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1529-9430(17)30321-2 DB - PRIME DP - Unbound Medicine ER -