Clinical StudyFrailty and sarcopenia do not predict adverse events in an elderly population undergoing non-complex primary elective surgery for degenerative conditions of the lumbar spine
Introduction
Sarcopenia is defined as a progressive loss of skeletal muscle mass, strength, and power associated with adverse outcomes and is a manifestation of musculoskeletal frailty [1], [2]. Psoas muscle size has been used as a measure of sarcopenia and has been shown to predict perioperative outcomes and mortality following major abdominal surgery [3], [4], [5], [6]. Frailty is similar but distinct from sarcopenia and is defined as “a state of increased vulnerability to poor resolution of homoeostasis after a stressor event, which increases the risk of adverse outcomes.” [1] Frailty represents a state of weakened reserve against even minor stressors and may not correlate to chronological age [1], [7]. The prevalence of frailty increases with age, is associated with increasing disability, admission to hospital, and death [8]. Its prevalence is higher in the overall surgical population (42%–50%) than the non-surgical elderly population (4%–10%) [1]. Frailty has been shown to independently predict postoperative complications in some surgical populations [9], [10], [11], [12], [13], including a subgroup of patients undergoing elective spine surgery [14], although the relationship between sarcopenia and outcomes has not been reported. As patients undergoing spine surgery experience a high rate of perioperative complications [15], frailty and sarcopenia may play an important role in risk prediction.
The population presenting for lumbar degenerative spine surgery is aging and presents challenges in perioperative risk stratification [16], [17]. In addition, traditional measures of frailty and strength may not discriminate well, given associated functional limitations. Defining the appropriate measurement tool and role of frailty in this population will not only facilitate appropriate patient selection but may offer opportunities for risk modification [7]. The primary objective of this study was to determine the relationship between sarcopenia, frailty, and postoperative adverse events (AEs). Secondary objectives were to determine the prevalence and distribution of sarcopenia as measured by psoas muscle area on computed tomography (CT) imaging and the relationship between sarcopenia, frailty, and postoperative outcomes such as length of stay, discharge to a facility, and in-hospital mortality in elderly patients undergoing primary elective thoracolumbar degenerative spine surgery.
Section snippets
Methods
We performed this ambispective cohort study with ethics approval from our Institutional Research Ethics Board (H14-02983) with a waiver for informed consent.
Results
A total of 425 patients met the inclusion criteria of which 323 were excluded based on the exclusion criteria, leaving 102 patients for final analysis (Fig. 2). The study population characteristics are provided in Table 1. The NTPA distribution was positively skewed in the population, particularly in women (Fig. 3).
Discussion
In this study, we investigated the use of NTPA and mFI as predictors of postoperative outcomes in a selected population of elderly patients undergoing routine surgery for lumbar degenerative disease. The mean NTPA was 674 (SD 278) mm2/m2, and 40% of our population was pre-frail or frail. We demonstrated that NTPA can be reliably and easily assessed in this population, assuming preoperative CT imaging is available. Body mass index and gender were independent predictors of the NTPA, but not
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Author disclosures: RCM: Nothing to disclose. JS: Fellowship Support: Medtronic and AOSpine (E, Paid directly to institution/employer), outside the submitted work. HZ: Nothing to disclose. TR: Nothing to disclose. TA: Nothing to disclose. MB: Nothing to disclose. MD: Royalties: Medtronic (H); Consulting: Medtronic (E); Endowments: Paetzold Chair (E, Paid to institution); Fellowship Support: BC Government, Medtronic, and AOSpine (F, Paid to institution), outside the submitted work. BK: Nothing to disclose. SP: Nothing to disclose. ND: Nothing to disclose. CGF: Royalties: Medtronic (G); Consulting: Medtronic and NuVasive (F); Grants: OREF (E, Paid to institution); Fellowship Support: BC Government, Medtronic, and AOSpine (F, Paid to institution), outside the submitted work. AMF: Nothing to disclose.
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