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

Charest-Morin, Raphaële; Street, John; Zhang, Honglin; Roughead, Taren; Ailon, Tamir; Boyd, Michael; Dvorak, Marcel F.; Kwon, Brian K.; Paquette, Scott; Dea, Nicolas; Fisher, Charles G.; Flexman, Alana M.

doi:10.1016/j.spinee.2017.07.003

Cited by 75 publications

(82 citation statements)

References 43 publications

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“…SSII was designed to quantify surgical invasiveness in the spinal surgery population [47]. Previous authors have reported a relation between SSII and the occurrence of postop adverse events in trauma and degenerative spine populations [36,48]. Our findings suggested that surgical invasiveness may not play a clinically significant role in this metastatic spinal population, at least not relative to the other putative clinical predictors.…”

Section: Discussionmentioning

confidence: 71%

Sarcopenia, but not frailty, predicts early mortality and adverse events after emergent surgery for metastatic disease of the spine

Bourassa-Moreau

Versteeg²,

Moskven

et al. 2020

The Spine Journal

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Section: Discussionmentioning

confidence: 71%

Sarcopenia, but not frailty, predicts early mortality and adverse events after emergent surgery for metastatic disease of the spine

Bourassa-Moreau

Versteeg²,

Moskven

et al. 2020

The Spine Journal

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“…In a cohort of patients over the age of 65 years undergoing elective surgery for degenerative conditions of the lumbar spine, modified frailty score was 0.09, with 59.8% being not frail, 20.6% pre-frail, and 19.6% frail. 38 In our cohort of patients over the age of 61 years, 30.6% were frail. When comparing the tSCI population with the elective surgery cohort, despite having a lower age limit of 61 versus 65 years, frailty is 1.5 times more common.…”

Section: Frailty In Traumatic Sci 843mentioning

confidence: 66%

“…When comparing the tSCI population with the elective surgery cohort, despite having a lower age limit of 61 versus 65 years, frailty is 1.5 times more common. 38 This difference is striking, particularly as the main cause of injury is through falls in our cohort, which may occur in more frail individuals. With the increase in the older population, this problem will likely be exacerbated and should be considered in future planning.…”

Section: Frailty In Traumatic Sci 843mentioning

confidence: 75%

“…37 With regard to spine surgery, most studies have similarly linked frailty and worsened post-operative outcomes, mortality, and discharge disposition. 38,39 Flexman and associates showed higher complication rates, specifically with infection, in a population of elective degenerative spine patients. 33 Ali and co-workers reviewed the 18,294 patients in the National Surgery Quality Improvement Program (NSQIP) database who had undergone spine surgery.…”

Section: Discussionmentioning

confidence: 99%

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Effect of Frailty on Outcome after Traumatic Spinal Cord Injury

Banaszek

Inglis

Marion

et al. 2020

Journal of Neurotrauma

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Frailty negatively affects outcome in elective spine surgery populations. This study sought to determine the effect of frailty on patient outcome after traumatic spinal cord injury (tSCI). Patients with tSCI were identified from our prospectively collected database from 2004 to 2016. We examined effect of patient age, admission Total Motor Score (TMS), and Modified Frailty Index (mFI) on adverse events (AEs), acute length of stay (LOS), in-hospital mortality, and discharge destination (home vs. other). Subgroup analysis (for three age groups: <60, 61-75, and 76+ years), and multi-variable analysis was performed to investigate the impact of age, TMS, and mFI on outcome. For the 634 patients, the mean age was 50.3 years, 77% were male, and falls were the main cause of injury (46.5%). On bivariate analysis, mFI, age at injury, and TMS were predictors of AEs, acute LOS, and in-hospital mortality. After statistical adjustment, mFI was a predictor of LOS ( p = 0.0375), but not of AEs ( p = 0.1428) or in-hospital mortality ( p = 0.1245). In patients <60 years of age, mFI predicted number of AEs, acute LOS, and in-hospital mortality. In those aged 61-75, TMS predicted AEs, LOS, and mortality. In those 76+ years of age, mFI no longer predicted outcome. Age, mFI, and TMS on admission are important determinants of outcome in patients with tSCI. mFI predicts outcomes in those <75 years of age only. The inter-relationship of advanced age and decreased physiological reserve is complex in acute tSCI, warranting further study. Identifying frailty in younger patients with tSCI may be useful for peri-operative optimization, risk stratification, and patient counseling.

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“…Regarding the measurement of sarcopenia, an ambispective study from Canada indicated that sarcopenia measured using normalized total psoas area did not predict acute care complications in elderly patients undergoing simple lumbar spine surgery for degenerative spinal diseases. The modification of the core abdominal musculature because of underlying degenerative spine disease could have precluded the risk stratification based on this measurement [96].…”

Section: Impact Of Spinal Sarcopenia On Surgical Interventions For Spmentioning

confidence: 99%

Novel Insights into the Pathogenesis of Spinal Sarcopenia and Related Therapeutic Approaches: A Narrative Review

Kuo

Lin

Lee

et al. 2020

IJMS

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Spinal sarcopenia is a complex and multifactorial disorder associated with a loss of strength, increased frailty, and increased risks of fractures and falls. In addition, spinal sarcopenia has been associated with lumbar spine disorders and osteoporosis, which renders making decisions on treatment modalities difficult. Patients with spinal sarcopenia typically exhibit lower cumulative survival, a higher risk of in-hospital complications, prolonged hospital stays, higher postoperative costs, and higher rates of blood transfusion after thoracolumbar spine surgery. Several studies have focused on the relationships between spinal sarcopenia, appendicular muscle mass, and bone-related problems—such as osteoporotic fractures and low bone mineral density—and malnutrition and vitamin D deficiency. Although several techniques are available for measuring sarcopenia, each of them has its advantages and shortcomings. For treating spinal sarcopenia, nutrition, physical therapy, and medication have been proven to be effective; regenerative therapeutic options seem to be promising owing to their repair and regeneration potential. Therefore, in this narrative review, we summarize the characteristics, detection methodologies, and treatment options for spinal sarcopenia, as well as its role in spinal disorders.

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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

Cited by 75 publications

References 43 publications

Sarcopenia, but not frailty, predicts early mortality and adverse events after emergent surgery for metastatic disease of the spine

Sarcopenia, but not frailty, predicts early mortality and adverse events after emergent surgery for metastatic disease of the spine

Effect of Frailty on Outcome after Traumatic Spinal Cord Injury

Novel Insights into the Pathogenesis of Spinal Sarcopenia and Related Therapeutic Approaches: A Narrative Review

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