A Comparative Analysis of Frailty, Disability, and Sarcopenia With Patient Characteristics and Outcomes in Adult Spinal Deformity Surgery

Abstract

Study Design Retrospective case series study. Objectives This study aims to compare preoperative indices, including the modified frailty index-11 (mFI-11), modified frailty index-5 (mFI-5), Oswestry Disability Index (ODI), and psoas muscle index (PMI), as they relate to outcomes in adult spinal deformity (ASD) surgery. Methods We identified 235 patients who underwent thoracolumbar ASD surgery (≥4 levels). The mFI-11, mFI-5, ODI, and PMI were determined from preoperative visits and correlated to outcome measures, including perioperative transfusion, duration of anesthesia, hospital and ICU length of stay (LOS), discharge disposition, readmission, change in ODI at last follow-up, revision surgery, and mortality. Results Our cohort had a mean age of 69.6 years and a male:female ratio of 1:2 with 177 undergoing an index surgery and 58 patients presenting after a failed multilevel fusion. The average number of levels fused was 9.3. The mFI-11 and mFI-5 were similar in predicting the need for intraoperative and postoperative transfusion. However, the mFI-11 was able to predict longer ICU and hospital LOS and mortality. The average preoperative ODI was 44.9% with an average decrease of 10.1% at the last follow-up. Preoperative ODI was the most significant predictor of postoperative change of ODI. Sarcopenia, defined as the lowest quartile of PMI values measured at L3 and L4, was not associated with any meaningful outcomes. Conclusion The mFI-11 better correlated with outcomes, indicating its increased prognostic value compared to other preoperative indices in ASD surgery. Preoperative ODI remains a significant predictor of postoperative change in ODI when evaluating ASD patients.

Impact of Sarcopenia on Spinal Spondylosis: A Literature Review

“…Most studies (n = 7 (36.8%) [ 10 , 11 , 12 , 13 , 14 , 15 , 16 ]) reported findings from Japan, while others reported findings from the United States (n = 5 [ 17 , 18 , 19 , 20 , 21 ]), Korea (n = 2 [ 22 , 23 ]), China (n = 2 [ 24 , 25 ]), Italy (n = 2 [ 26 , 27 ]), and Taiwan (n = 1 [ 8 ]). Table 2 summarizes the characteristics of the included articles.…”

“…Table 2 summarizes the characteristics of the included articles. The target diseases were CSM (n = 2 [ 11 , 20 ]), LDSD (n = 9 [ 8 , 12 , 13 , 18 , 21 , 23 , 24 , 26 , 27 ]), lumbar spinal stenosis (LSS; n = 6 [ 10 , 14 , 15 , 16 , 22 , 25 ]), and ASD (n = 1 [ 19 ]). One study evaluated patients who underwent thoracolumbar surgery (n = 1 [ 17 ]).…”

“…Regarding the publication language, excluding one report in Chinese [ 25 ], all the included articles were in English. Fifteen articles were retrospective observational studies [ 10 , 12 , 13 , 14 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 ], three were prospective observational studies [ 11 , 15 , 16 ], and one was a meta-analysis (LDSD) [ 8 ]. However, no intervention studies for SS and sarcopenia were available in any of the explored databases.…”

“…Four articles evaluated the cross-sectional area of the psoas muscle [ 17 , 19 , 26 , 27 ]; the prevalence of sarcopenia ranged between 18.1 and 50.7%. Three articles evaluated sarcopenia according to the AWGS criteria [ 13 , 14 , 24 ], revealing that the prevalence of sarcopenia was 14.0, 20.0, and 23.1%, respectively.…”

“…Based on the studies included in the present review, the presence or absence of sarcopenia did not alter perioperative management. Five reports revealed that patients with SS and sarcopenia had decreased postoperative disease-specific QOL [ 10 , 12 , 20 , 22 , 24 ], whereas three reports found no significant postoperative differences between the sarcopenia and control groups [ 14 , 18 , 19 ]. A meta-analysis by Wu et al, which included several of the abovementioned studies, summarized the effects of sarcopenia on LDSD and found that the postoperative QOL was significantly lower in the sarcopenia group than that in the non-sarcopenia group [ 8 ].…”