PMID- 31479782 OWN - NLM STAT- MEDLINE DCOM- 20200911 LR - 20210320 IS - 1878-1632 (Electronic) IS - 1529-9430 (Linking) VI - 20 IP - 1 DP - 2020 Jan TI - Sarcopenia, but not frailty, predicts early mortality and adverse events after emergent surgery for metastatic disease of the spine. PG - 22-31 LID - S1529-9430(19)30958-1 [pii] LID - 10.1016/j.spinee.2019.08.012 [doi] AB - BACKGROUND CONTEXT: Frailty and sarcopenia variably predict adverse events (AEs) in a number of surgical populations. PURPOSE: The aim of this study was to investigate the ability of frailty and sarcopenia to independently predict early mortality and AEs following urgent surgery for metastatic disease of the spine. STUDY DESIGN: A single institution, retrospective cohort study. PATIENT SAMPLE: One hundred eight patients undergoing urgent surgery for spinal metastases from 2009 to 2015. OUTCOME MEASURES: The incidence of AEs including 1- and 3-month mortality. METHODS: Sarcopenia was defined using the L3 Total Psoas Area/Vertebral body Area (L3-TPA/VB) technique on CT. The modified Frailty Index (mFI), Metastatic Frailty Index (MSTFI) and the Bollen prognostic scales were calculated for each patient. Additional data included demographics, tumor type and burden, neurological status, the extent of surgical treatment and the use of radiation-therapy. Spearman correlation test, logistic regression and Kaplan-Meier were used to study the relation between the outcomes measures and potential predictors (L3-TPA/VB, MSTFI, mFI, and the Bollen prognostic scales). RESULTS: Eighty-five percent of patients had at least one acute AE. Sarcopenia predicted the occurrence of at least one postop AE (L3-TPA/VB, 1.07+/-0.40 vs. 1.25+/-0.52; p=.031). Sarcopenia (L3-TPA/VB) and the degree of neurological impairment were predictive of postoperative AE but MFI or MSTFI were not. Sarcopenia predicted 3-month mortality, independent of primary tumor type (L3-TPA/VB: 0.86+/-0.27 vs. 1.12+/-0.41; p<.001). Kaplan-Meyer analysis showed L3-TPA/VB and the Bollen Scale to significantly discriminate patient survival. CONCLUSIONS: Sarcopenia, easily measured by the L3-TPA/VB on conventional CT, predicts both early postoperative mortality and adverse events in patients undergoing urgent surgery for spinal metastasis, thus providing a practical tool for timely therapeutic decision-making in this complex patient population. CI - Copyright (c) 2019. Published by Elsevier Inc. FAU - Bourassa-Moreau, Etienne AU - Bourassa-Moreau E AD - Hopital du Sacre-Coeur de Montreal, 5400 Boulevard Gouin Ouest, Montreal, Quebec, H4J 1C5, Canada. Electronic address: etienne.bourassamoreau@gmail.com. FAU - Versteeg, Anne AU - Versteeg A AD - University Medical Center Utrech, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands. FAU - Moskven, Eryck AU - Moskven E AD - Vancouver General Hospital, Vancouver Spine Surgery Institute, 818 west 10th Avenue, Vancouver, British Columbia, V5Z 1M9 Canada. FAU - Charest-Morin, Raphaele AU - Charest-Morin R AD - Vancouver General Hospital, Vancouver Spine Surgery Institute, 818 west 10th Avenue, Vancouver, British Columbia, V5Z 1M9 Canada. FAU - Flexman, Alana AU - Flexman A AD - Vancouver General Hospital, Vancouver Spine Surgery Institute, 818 west 10th Avenue, Vancouver, British Columbia, V5Z 1M9 Canada. FAU - Ailon, Tamir AU - Ailon T AD - Vancouver General Hospital, Vancouver Spine Surgery Institute, 818 west 10th Avenue, Vancouver, British Columbia, V5Z 1M9 Canada. FAU - Dalkilic, Turker AU - Dalkilic T AD - University of Saskatchewan, Regina General Hospital, 3rd Floor Medical office wing, 1440 14th Ave. Regina, S4P 0W5 Canada. FAU - Fisher, Charles AU - Fisher C AD - Vancouver General Hospital, Vancouver Spine Surgery Institute, 818 west 10th Avenue, Vancouver, British Columbia, V5Z 1M9 Canada. FAU - Dea, Nicolas AU - Dea N AD - Vancouver General Hospital, Vancouver Spine Surgery Institute, 818 west 10th Avenue, Vancouver, British Columbia, V5Z 1M9 Canada. FAU - Boyd, Michael AU - Boyd M AD - Vancouver General Hospital, Vancouver Spine Surgery Institute, 818 west 10th Avenue, Vancouver, British Columbia, V5Z 1M9 Canada. FAU - Paquette, Scott AU - Paquette S AD - Vancouver General Hospital, Vancouver Spine Surgery Institute, 818 west 10th Avenue, Vancouver, British Columbia, V5Z 1M9 Canada. FAU - Kwon, Brian AU - Kwon B AD - Vancouver General Hospital, Vancouver Spine Surgery Institute, 818 west 10th Avenue, Vancouver, British Columbia, V5Z 1M9 Canada. FAU - Dvorak, Marcel AU - Dvorak M AD - Vancouver General Hospital, Vancouver Spine Surgery Institute, 818 west 10th Avenue, Vancouver, British Columbia, V5Z 1M9 Canada. FAU - Street, John AU - Street J AD - Vancouver General Hospital, Vancouver Spine Surgery Institute, 818 west 10th Avenue, Vancouver, British Columbia, V5Z 1M9 Canada. LA - eng PT - Journal Article DEP - 20190901 PL - United States TA - Spine J JT - The spine journal : official journal of the North American Spine Society JID - 101130732 SB - IM CIN - Spine J. 2020 Nov;20(11):1887. PMID: 33138969 MH - Adult MH - Aged MH - Female MH - Frailty/complications/*epidemiology MH - Humans MH - Incidence MH - Male MH - Middle Aged MH - Neurosurgical Procedures/adverse effects MH - Postoperative Complications/*epidemiology MH - Prognosis MH - Sarcopenia/complications/*epidemiology MH - Spinal Neoplasms/*complications/mortality/surgery OTO - NOTNLM OT - Adverse event OT - Frailty OT - Sarcopenia OT - Spinal metastasis OT - Spinal surgery OT - Survival EDAT- 2019/09/04 06:00 MHDA- 2020/09/12 06:00 CRDT- 2019/09/04 06:00 PHST- 2019/03/21 00:00 [received] PHST- 2019/08/22 00:00 [revised] PHST- 2019/08/23 00:00 [accepted] PHST- 2019/09/04 06:00 [pubmed] PHST- 2020/09/12 06:00 [medline] PHST- 2019/09/04 06:00 [entrez] AID - S1529-9430(19)30958-1 [pii] AID - 10.1016/j.spinee.2019.08.012 [doi] PST - ppublish SO - Spine J. 2020 Jan;20(1):22-31. doi: 10.1016/j.spinee.2019.08.012. Epub 2019 Sep 1.