Central Sarcopenia, Frailty and Comorbidity as Predictor of Surgical Outcome in Elderly Patients with Degenerative Spine Disease

Abstract

Objective : People are living longer and the elderly population continues to increase. The incidence of degenerative spinal diseases (DSDs) in the elderly population is quite high. Therefore, we are facing more cases of DSD and offering more surgical solutions in geriatric patients. Understanding the significance and association of frailty and central sarcopenia as risk factors for spinal surgery in elderly patients will be helpful in improving surgical outcomes. We conducted a retrospective cohort analysis of prospectively collected data to assess the impact of preoperative central sarcopenia, frailty, and comorbidity on surgical outcome in elderly patients with DSD. Methods : We conducted a retrospective analysis of patients who underwent elective spinal surgery performed from January 1, 2019 to September 30, 2020 at our hospital. We included patients aged 65 and over who underwent surgery on the thoracic or lumbar spine and were diagnosed as DSD. Central sarcopenia was measured by the 50th percentile of psoas : L4 vertebral index (PLVI) using the cross-sectional area of the psoas muscle. We used the Korean version of the fatigue, resistance, ambulation, illnesses, and loss of weight (K-FRAIL) scale to measure frailty. Comorbidity was confirmed and scored using the Charlson Comorbidity Index (CCI). As a tool for measuring surgical outcome, we used the Clavien-Dindo (CD) classification for postoperative complications and the length of stay (LOS). Results : This study included 85 patients (35 males and 50 females). The mean age was 74.05±6.47 years. Using the K-FRAIL scale, four patients were scored as robust, 44 patients were pre-frail and 37 patients were frail. The mean PLVI was 0.61±0.19. According to the CD classification, 50 patients were classified as grade 1, 19 as grade 2, and four as grade 4. The mean LOS was 12.35±8.17 days. Multivariate stepwise regression analysis showed that postoperative complication was significantly associated with surgical invasiveness and K-FRAIL scale. LOS was significantly associated with surgical invasiveness and CCI. K-FRAIL scale showed a significant correlation with CCI and PLVI. Conclusion :The present study demonstrates that frailty, comorbidity, and surgical invasiveness are important risk factors for postoperative complications and LOS in elderly patients with DSD. Preoperative recognition of these factors may be useful for perioperative optimization, risk stratification, and patient counseling.

Association Between the FRAIL Scale and Postoperative Complications in Older Surgical Patients: A Systematic Review and Meta-Analysis

“…A total of 18 studies with 4479 participants [21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38] were included after screening 7800 citations and 85 fulltext articles (Figure 1). An additional 4 studies were found to match our inclusion and exclusion criteria [39][40][41][42] ; however, they were missing necessary data for our analysis (ie, percent frail) [39][40][41] or used the same population as a previously published study. 42 Authors were contacted for additional data, and studies were excluded if authors did not respond or provide the additional data.…”

Optimizing Perioperative Nutrition for Spine Surgery

“…The average age was 74.5 years with outcomes measured using Clavien-Dindo classification, confirmation of comorbidity scored using the Charlson Comorbidity Index (CCI), and frailty measured using the Fatigue, Resistance, Ambulation, Illnesses, and Loss of Weight Scale (FRAIL). 17 Kim et al 17 concluded elderly patients with increased malnutrition and frailty had an increased adverse effect rate associated with worse performance on outcome measures, disability.…”

Optimizing Perioperative Nutrition for Spine Surgery

“…Also associated with poor nutritional intake in the elderly is the presence of frailty defined as age-related reduction in physical function and sarcopenia defined as reduced function second to progressive loss of muscle mass 17…”

“…A retrospective study conducted by Kim et al17 investigated the impact of frailty and sarcopenia on 85 patients undergoing elective lumbar or thoracic spine surgery outcomes. The average age was 74.5 years with outcomes measured using Clavien-Dindo classification, confirmation of comorbidity scored using the Charlson Comorbidity Index (CCI), and frailty measured using the Fatigue, Resistance, Ambulation, Illnesses, and Loss of Weight Scale (FRAIL) 17. Kim et al17 concluded elderly patients with increased malnutrition and frailty had an increased adverse effect rate associated with worse performance on outcome measures, disability.…”