PMID- 28709946 OWN - NLM STAT- MEDLINE DCOM- 20181121 LR - 20220330 IS - 1878-1632 (Electronic) IS - 1529-9430 (Linking) VI - 18 IP - 2 DP - 2018 Feb TI - 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. PG - 245-254 LID - S1529-9430(17)30321-2 [pii] LID - 10.1016/j.spinee.2017.07.003 [doi] AB - 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 mm(2)/m(2) (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 mm(2)/m(2), 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 mm(2)/m(2), p=.70), or death (OR 1.12 (95% CI 0.83-1.53) per 100 mm(2)/m(2), 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. CI - Crown Copyright (c) 2017. Published by Elsevier Inc. All rights reserved. FAU - Charest-Morin, Raphaele AU - Charest-Morin R AD - Department of Orthopedic Surgery, Laval University, 1401 18e rue, Local B-2408, Quebec, QC G1J 1Z4, Canada. Electronic address: raphaele.charest-morin.1@ulaval.ca. FAU - Street, John AU - Street J AD - 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. FAU - Zhang, Honglin AU - Zhang H AD - Centre for Hip Health and Mobility, Department of Orthopedic Surgery, University of British Columbia, 466-2635 Laurel St, Vancouver, BC V5Z 1M9, Canada. FAU - Roughead, Taren AU - Roughead T AD - Department of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC V6T 1Z3, Canada. FAU - Ailon, Tamir AU - Ailon T AD - 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. FAU - Boyd, Michael AU - Boyd M AD - 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. FAU - Dvorak, Marcel AU - Dvorak M AD - 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. FAU - Kwon, Brian AU - Kwon B AD - 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. FAU - Paquette, Scott AU - Paquette S AD - 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. FAU - Dea, Nicolas AU - Dea N AD - Division of Neurosurgery, Department of Surgery, Centre Universitaire Hospitalier de Sherbrooke, 3001, 12th Ave North, Local 5110, Sherbrooke, QC J1H 5N4, Canada. FAU - Fisher, Charles G AU - Fisher CG AD - 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. FAU - Flexman, Alana M AU - Flexman AM AD - 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. LA - eng PT - Journal Article DEP - 20170712 PL - United States TA - Spine J JT - The spine journal : official journal of the North American Spine Society JID - 101130732 SB - IM MH - Aged MH - Aged, 80 and over MH - Elective Surgical Procedures/*adverse effects MH - Female MH - Frail Elderly MH - Frailty/*complications MH - Humans MH - Incidence MH - Lumbar Vertebrae/*surgery MH - Male MH - Neurosurgical Procedures/*adverse effects MH - Orthopedic Procedures/*adverse effects MH - Postoperative Complications/*epidemiology/etiology MH - Reproducibility of Results MH - Risk Factors MH - Sarcopenia/*complications MH - Spinal Diseases/complications/*surgery OTO - NOTNLM OT - Adverse event OT - Complication OT - Frailty OT - Modified frailty index OT - Sarcopenia OT - Spine OT - Total psoas muscle area EDAT- 2017/07/16 06:00 MHDA- 2018/11/22 06:00 CRDT- 2017/07/16 06:00 PHST- 2017/03/24 00:00 [received] PHST- 2017/05/31 00:00 [revised] PHST- 2017/07/06 00:00 [accepted] PHST- 2017/07/16 06:00 [pubmed] PHST- 2018/11/22 06:00 [medline] PHST- 2017/07/16 06:00 [entrez] AID - S1529-9430(17)30321-2 [pii] AID - 10.1016/j.spinee.2017.07.003 [doi] PST - ppublish SO - Spine J. 2018 Feb;18(2):245-254. doi: 10.1016/j.spinee.2017.07.003. Epub 2017 Jul 12.