Journal Article

Effect of Sarcopenia on Postoperative Morbidity and Mortality After Thoracolumbar Spine Surgery

Eltorai, Adam E. M., Palumbo, Mark A., Han, Alex L., Daniels, Alan H., Marcaccio, Stephen E., Bokshan, Steven L., DePasse, J. Mason

2016

Overview

Sarcopenia is the loss of muscle mass associated with aging and advanced disease. This study retrospectively examined patients older than 55 years (N=46) who underwent thoracolumbar spine surgery between 2003 and 2015. Each patient's comorbidity burden was determined using the Charlson Comorbidity Index, and the Mirza Surgical Invasiveness Index was used to measure procedural complexity. Sarcopenia was diagnosed by measuring the total cross-sectional area of the psoas muscle at the L4 vertebrae using perioperative computed tomography scans. Of the 46 patients assessed, 16 were in the lowest third for L4 total psoas area (sarcopenic). Average follow-up time was 5.2 years (range, 6 days to 12.7 years). The cohort of patients with sarcopenia was significantly older than the cohort without sarcopenia (mean age, 76.4 vs 69.9 years; P =.01) but did not have a significantly different mean Charlson Comorbidity Index (3.3 vs 2.0; P =.32) or mean Mirza Surgical Invasiveness Index (7.1 vs 7.0; P =.49). Patients with sarcopenia had a hospital length of stay 1.7-fold longer than those without sarcopenia (8.1 vs 4.7 days; P =.02) and a 3-fold increase in postoperative in-hospital complications (1.2 vs 0.4; P =.02), and they were more likely to require discharge to a rehabilitation or nursing facility (81.2% vs 43.3%; P =.006). Patients with sarcopenia had a significantly lower cumulative survival (log rank=0.007). All 4 deaths occurred among patients with sarcopenia. Patients with sarcopenia have a significantly increased risk of in-hospital complications, longer length of stay, increased rates of discharge to rehabilitation facilities, and increased mortality following thoracolumbar spinal surgery, making sarcopenia a useful perioperative risk stratification tool. [ Orthopedics. 2016; 39(6):e1159–e1164.]

• Publisher: SLACK INCORPORATED
• Subject: Aged / Aged, 80 and over / Back surgery / Comorbidity / Cost control / Female / Hospitals / Humans / Length of stay / Lumbar Vertebrae - surgery / Male / Medical imaging / Middle Aged / Morbidity / Mortality / Orthopedic Procedures - adverse effects / Orthopedic Procedures - mortality / Patients / Postoperative Complications - epidemiology / Postoperative Complications - mortality / Postoperative Period / Psoas Muscles - diagnostic imaging / Psoas Muscles - pathology / Retrospective Studies / Risk Assessment / Sarcopenia / Sarcopenia - complications / Sarcopenia - epidemiology / Sarcopenia - mortality / Software / Spine - surgery / Surgical outcomes / Thoracic Vertebrae - surgery / Tomography, X-Ray Computed / Transplants & implants / Variance analysis