Is Sarcopenia a Risk Factor for Postoperative Surgical Site Infection After Posterior Lumbar Spinal Fusion?

Abstract

Background: This retrospective observational study aimed to evaluate the impact of sarcopenia on surgical site infection (SSI) risk in patients who undergo posterior lumbar fusion. While many studies have investigated the impact of sarcopenia on postoperative morbidity both in general and orthopedic surgery, none of them examined the risk of postoperative infection after lumbar spine surgery in sarcopenic vs nonsarcopenic patients.Methods: Consecutive 55-to 75-year-old patients who underwent short posterior lumbar fusion for degenerative pathology between 2004 and 2019 were included. Charts were reviewed, and the psoas:lumbar vertebral index (PLVI) was used as a measure of central sarcopenia. Patients were stratified according to low vs high PLVI and then according to postoperative infection status. SSI was assessed as an outcome. A statistical analysis was performed to identify risk factors for infection.Results: A total of 304 patients were included; 24 (7.9%) developed postoperative SSI. The average follow-up was 26.2 months. The sarcopenic group was found to not have a higher likelihood of experiencing postoperative SSI (P = 0.947). Only Charlson Comorbidity Index and American Society of Anesthesiology score were significantly associated with infectious complications (P = 0.008 and P = 0.017, respectively).Conclusions: Low PLVI was not associated with postoperative SSI in this study. This finding is in contrast with the findings of other authors who found sarcopenia to be a risk factor for postoperative complications. However, these studies did not consider SSI as the only primary endpoint, and patients were not stratified by indication (degeneration, infection, tumor, and trauma) or surgical procedure.Clinical Relevance: Low PLVI was not associated with postoperative SSI in patients who undergo short posterior lumbar fusion for degenerative pathology.

Sarcopenia in Lumbar and Cervical Spine Surgery

“…[8][9][10][11] Despite the large heterogeneity of current studies, initial literature in spine surgery has demonstrated that sarcopenia may serve as an independent prognostic factor for increased rates of osteoporotic fractures, increased health care costs, and nonhome discharge. [12][13][14] For example, a study of patients who suffered from osteovertebral fracture after dorsal spine instrumentation determined sarcopenia, as defined by EWGSOP criteria of SMA (skeletal muscle area) and SMD (skeletal muscle density), a prognostic marker of instrument failure. 12 Two further retrospective studies analyzed the rates of complications in patients undergoing short-segment posterior arthrodesis for lumbar degenerative disease when stratifying for sarcopenia as measured through the psoas lumbar vertebral index (PLVI).…”

“…13,14 Both studies only consisted of ~300 patients, and determined surgical site infections were not found to be linked to sarcopenia; however, one study demonstrated sarcopenic patients were more likely to have increased operative times and inpatient length of stay (LOS). 13,14 Furthermore, 2 further retrospective studies demonstrated that sarcopenia, as assessed through the PLVI, increased total inpatient hospital cost, LOS, and rates of nonhome discharge. 15,16 Given the relatively recent introduction of a designated ICD code for sarcopenia in 2016, there is a current lack of large database analysis analyzing the independent risk of sarcopenia for complications and health care use.…”

“…Despite the large heterogeneity of current studies, initial literature in spine surgery has demonstrated that sarcopenia may serve as an independent prognostic factor for increased rates of osteoporotic fractures, increased health care costs, and nonhome discharge 12–14. For example, a study of patients who suffered from osteovertebral fracture after dorsal spine instrumentation determined sarcopenia, as defined by EWGSOP criteria of SMA (skeletal muscle area) and SMD (skeletal muscle density), a prognostic marker of instrument failure 12.…”

“…For example, a study of patients who suffered from osteovertebral fracture after dorsal spine instrumentation determined sarcopenia, as defined by EWGSOP criteria of SMA (skeletal muscle area) and SMD (skeletal muscle density), a prognostic marker of instrument failure 12. Two further retrospective studies analyzed the rates of complications in patients undergoing short-segment posterior arthrodesis for lumbar degenerative disease when stratifying for sarcopenia as measured through the psoas lumbar vertebral index (PLVI) 13,14. Both studies only consisted of ∼300 patients, and determined surgical site infections were not found to be linked to sarcopenia; however, one study demonstrated sarcopenic patients were more likely to have increased operative times and inpatient length of stay (LOS) 13,14.…”

Sarcopenia in Lumbar and Cervical Spine Surgery

“…12 Two further retrospective studies analyzed the rates of complications in patients undergoing short-segment posterior arthrodesis for lumbar degenerative disease when stratifying for sarcopenia as measured through the psoas lumbar vertebral index (PLVI). 13,14 Both studies only consisted of ~300 patients, and determined surgical site infections were not found to be linked to sarcopenia; however, one study demonstrated sarcopenic patients were more likely to have increased operative times and inpatient length of stay (LOS). 13,14 Furthermore, 2 further retrospective studies demonstrated that sarcopenia, as assessed through the PLVI, increased total inpatient hospital cost, LOS, and rates of nonhome discharge.…”