Inpatient costs and blood transfusion rates of sarcopenic patients following thoracolumbar spine surgery

Abstract

<jats:sec><jats:title>OBJECTIVE</jats:title><jats:p>Sarcopenia, the muscle atrophy associated with aging and disease progression, accounts for nearly $18.5 billion in health care expenditures annually. Given the high prevalence of sarcopenia in patients undergoing orthopedic surgery, the goal of this study was to assess the impact of sarcopenia on inpatient costs following thoracolumbar spine surgery.</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>Patients older than 55 years undergoing thoracolumbar spine surgery from 2003 to 2015 were retrospectively analyzed. Sarcopenia was measured using total psoas area at the L-4 vertebra on perioperative CT scans. Hospital billing data were used to compare inpatient costs, transfusion rate, and rate of advanced imaging utilization.</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>Of the 50 patients assessed, 16 were sarcopenic. Mean total hospital costs were 1.75-fold greater for sarcopenic patients compared with nonsarcopenic patients ($53,128 vs $30,292, p = 0.04). Sarcopenic patients were 2.1 times as likely to require a blood transfusion (43.8% vs 20.6%, p = 0.04). Sarcopenic patients had a 2.6-fold greater usage of advanced imaging (68.8% vs 26.5%, p = 0.002) with associated higher diagnostic imaging costs ($2452 vs $801, p = 0.01). Sarcopenic patients also had greater pharmacy, laboratory, respiratory care, and emergency department costs.</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p>This study is the first to show that sarcopenia is associated with higher postoperative costs and rates of blood transfusion following thoracolumbar spine surgery. Measuring the psoas area may represent a strategy for predicting perioperative costs in spine surgery patients.</jats:p></jats:sec>

Comparative Analysis on the Effects of Sarcopenia following Primary Total Knee Arthroplasty: A Retrospective Matched-Control Analysis

“…5,21,30,31 While studies analyzing relationship between sarcopenia and TKA specifically are severely limited, data from other surgical specialties and orthopaedic subspecialties increasingly demonstrate greater postoperative medical complication risk in sarcopenic patients. 4,5,21,30,32,33 Associations between sarcopenia and impaired kidney function are well established in the literature. 34,35 Nearly 37% of dialysis dependent chronic kidney disease (CKD) patients and 5 to 9% of early stage CKD patients suffer from sarcopenia.…”

The health economics burden of sarcopenia: a systematic review

“…After the process of selection based on abstract and title and after on the full-text article review ( Fig. 1), we finally included 14 studies assessing the difference in health care costs between individuals with or without sarcopenia [10][11][12][13][14][15][16][17][18][19][20][21][22][23]. Sixteen studies were rejected because of duplicate (n = 2) [11,20], wrong outcomes (n = 13) [24][25][26][27][28][29][30][31][32][33][34][35][36] or wrong exposure factor (n = 1) [38].…”

“…A complete presentation of the characteristics and design of the 14 included studies [10][11][12][13][14][15][16][17][18][19][20][21][22][23] is accessible in Table 3. All studies, specifically regarding their analysis of sarcopenia-related costs, followed a cross-sectional design and was comprised of 50 to 1593 participants.…”

“…The way to diagnose sarcopenia was indeed very heterogeneous, the diagnostic thresholds being also arbitrarily placed for the majority of the included studies. For instance, 11 studies out of 14 [11][12][13][14][15][16][17][18]20,22,23] applied diagnostic thresholds according to the results intrinsic to their own study and population (i.e., lowest tertile or quartile) and not based on data validated and recognized in the scientific literature, as used by the three other studies [10,19,21]. However, when applicable, the cut-offs used to measure muscle strength and physical performance were all based on more robust scientific evidence.…”

“…Even if one study [21] obtained the maximum score (8 points), the other assessed studies received a moderate-quality score (around 4 points). The details of scoring are transcribed in Table 4, but, globally, two criteria of a good methodological quality were not met for most of the researches: -The standardized assessment and diagnosis of the exposure (i.e., presence of sarcopenia or not): not met for 11 studies out of 14 [10][11][12][13][15][16][17][18]20,22,23]; -The identification and deal of confounding factors: not met for 10 out of 14 studies [10][11][12]14,[16][17][18][19][20]22].…”