PMID- 33561547 OWN - NLM STAT- MEDLINE DCOM- 20210728 LR - 20220105 IS - 1878-1632 (Electronic) IS - 1529-9430 (Linking) VI - 21 IP - 6 DP - 2021 Jun TI - Sarcopenia predicts perioperative adverse events following complex revision surgery for the thoracolumbar spine. PG - 1001-1009 LID - S1529-9430(21)00062-0 [pii] LID - 10.1016/j.spinee.2021.02.001 [doi] AB - BACKGROUND CONTEXT: Sarcopenia measured by psoas muscle index (PMI) has been shown to predict perioperative mortality and adverse events (AEs) after various surgical procedures. However, this relationship has not been studied in complex revision thoracolumbar spine surgery. PURPOSE: This study aimed to determine the relationship between sarcopenia and perioperative AEs among patients undergoing complex revision thoracolumbar spine surgery. STUDY DESIGN: Retrospective cohort study PATIENT SAMPLE: A retrospective analysis was performed at a single institution between May 2016 and February 2020 of patients undergoing complex revision thoracolumbar spine surgery by three board certified fellowship-trained orthopaedic spine surgeons. OUTCOME MEASURES: Perioperative adverse events including postoperative anemia requiring transfusion, cardiac complication, sepsis, wound complication, delirium, intra-operative dural tear, acute kidney injury, pneumonia, urinary tract infection, urinary retention, epidural hematoma, and deep vein thrombosis. Secondary outcome measures were 30-day readmission rates, 30-day re-operation rates, in-hospital mortality rates, discharge disposition, and postoperative length of stay (LOS). METHODS: Sarcopenia was analyzed using PMI, calculated at the L3 vertebral body measured on preoperative magnetic resonance imaging (MRI) or computed tomography (CT) normalized to height(2) (mm(2)/m(2)). Receiver operating characteristic (ROC) curve analysis and Youden index were used to determine gender-specific PMI cut-off values for predicting perioperative AEs. Sarcopenia was defined as PMI below the cut-off values. Complex revision surgery was defined as Spine Surgical Invasiveness Index >10. RESULTS: A total of 114 consecutive patients were included in the study. ROC curve analysis demonstrated PMI <500 mm(2)/m(2) for males and <412 mm(2)/m(2) for females as predictors for perioperative AEs. 49 patients were in the sarcopenia cohort and 65 patients in the nonsarcopenia cohort. The sarcopenia group had higher overall perioperative AEs (75.5% vs 27.7%, p<.001) and individual AEs including: postoperative anemia requiring transfusion, wound complication, delirium, acute kidney injury, pneumonia, urinary tract infection, and deep vein thrombosis. The sarcopenia group had higher 30-day reoperation rate (14.3% vs 3.1%, p=.037), 30-day readmission rate (16.3% vs 3.1%, p=.018), rate of discharge to a facility (83.7% vs 50.8%, p<.001), and longer length of stay (LOS) (7.3+/-4.2 days vs 5.6+/-3.5 days, p=.023). CONCLUSIONS: Sarcopenia measured by PMI is associated with higher perioperative AEs, 30-day readmission rates, 30-day reoperation rates, rate of discharge to a facility, and longer LOS among patients undergoing complex revision thoracolumbar spine surgery. CI - Copyright (c) 2021 Elsevier Inc. All rights reserved. FAU - Hirase, Takashi AU - Hirase T AD - Department of Orthopedics and Sports Medicine, Houston Methodist Hospital, 6445 Main St Suite 2500, Houston, TX, USA. FAU - Haghshenas, Varan AU - Haghshenas V AD - Department of Orthopedics and Sports Medicine, Houston Methodist Hospital, 6445 Main St Suite 2500, Houston, TX, USA. FAU - Bratescu, Rachel AU - Bratescu R AD - Department of Orthopedics and Sports Medicine, Houston Methodist Hospital, 6445 Main St Suite 2500, Houston, TX, USA. FAU - Dong, David AU - Dong D AD - Department of Orthopedics and Sports Medicine, Houston Methodist Hospital, 6445 Main St Suite 2500, Houston, TX, USA. FAU - Kuo, Peggy H AU - Kuo PH AD - Department of Orthopedics and Sports Medicine, Houston Methodist Hospital, 6445 Main St Suite 2500, Houston, TX, USA. FAU - Rashid, Aymen AU - Rashid A AD - Department of Orthopedics and Sports Medicine, Houston Methodist Hospital, 6445 Main St Suite 2500, Houston, TX, USA. FAU - Kavuri, Venkat AU - Kavuri V AD - Department of Orthopedics and Sports Medicine, Houston Methodist Hospital, 6445 Main St Suite 2500, Houston, TX, USA. FAU - Hanson, Darrell S AU - Hanson DS AD - Department of Orthopedics and Sports Medicine, Houston Methodist Hospital, 6445 Main St Suite 2500, Houston, TX, USA. FAU - Meyer, B Christoph AU - Meyer BC AD - Department of Orthopedics and Sports Medicine, Houston Methodist Hospital, 6445 Main St Suite 2500, Houston, TX, USA. FAU - Marco, Rex A W AU - Marco RAW AD - Department of Orthopedics and Sports Medicine, Houston Methodist Hospital, 6445 Main St Suite 2500, Houston, TX, USA. Electronic address: rexmarco@gmail.com. LA - eng PT - Journal Article DEP - 20210207 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. 2021 Nov;21(11):1950-1951. PMID: 34749957 MH - Female MH - Humans MH - Male MH - Postoperative Complications/epidemiology/etiology MH - Reoperation MH - Retrospective Studies MH - *Sarcopenia/diagnostic imaging MH - Spine OTO - NOTNLM OT - Complex OT - Cut-off OT - Predictor OT - Psoas muscle OT - Revision thoracolumbar spine surgery OT - Sarcopenia EDAT- 2021/02/10 06:00 MHDA- 2021/07/29 06:00 CRDT- 2021/02/09 20:09 PHST- 2020/09/05 00:00 [received] PHST- 2021/02/01 00:00 [revised] PHST- 2021/02/05 00:00 [accepted] PHST- 2021/02/10 06:00 [pubmed] PHST- 2021/07/29 06:00 [medline] PHST- 2021/02/09 20:09 [entrez] AID - S1529-9430(21)00062-0 [pii] AID - 10.1016/j.spinee.2021.02.001 [doi] PST - ppublish SO - Spine J. 2021 Jun;21(6):1001-1009. doi: 10.1016/j.spinee.2021.02.001. Epub 2021 Feb 7.