Sarcopenia predicts perioperative adverse events following complex revision surgery for the thoracolumbar spine

Hirase, Takashi; Haghshenas, Varan; Bratescu, Rachel; Dong, David; Kuo, Peggy H.; Rashid, Aymen; Kavuri, Venkat; Hanson, Darrell S; Meyer, B; Marco, Rex A.W.

doi:10.1016/j.spinee.2021.02.001

Cited by 48 publications

(54 citation statements)

References 24 publications

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“…A recent study by Hirase et al demonstrated that sarcopenia, de ned by psoas muscle index (PMI) below 500 mm 2 /m 2 for males and 412 mm 2 /m 2 for females, is predictive of increased perioperative AEs among patients undergoing complex revision thoracolumbar spine surgery. 14 However, this study reported a signi cantly lower BMI among sarcopenic patients, indicating the presence of a possible confounding factor for predicting perioperative AEs within this patient cohort. Our understanding is that there are no previous studies that evaluate the effect of obesity status on patients undergoing complex revision thoracolumbar spine surgery.…”

Section: Introductionmentioning

confidence: 56%

“…The same patient cohort and similar methodologies were utilized from our previous publication by Hirase et al 14 The local institutional review board approved the study procedure on April 13, 2020. Due to the retrospective observational nature of this study, the informed consent was waived.…”

Section: Methodsmentioning

confidence: 99%

“…The total CSA was measured using OsiriX DICOM Viewer software (Version 11.0, Bernex, Switzerland) by manual outlining the bilateral psoas muscles at the rst axial cut, done in the craniocaudal direction where both transverse processes are visible at the L3 level. 14,15 All of the images were obtained at a single institution with the same scanning protocols ensuring identical scanning thickness among all images analyzed. Three separate reviewers performed all measurements to improve interobserver reliability.…”

Section: Assessment Of Sarcopeniamentioning

confidence: 99%

“…The same inclusion and exclusion criteria for the same cohort of patients from our previous publication by Hirase et al was applied for this study. 14 Any patients age 18 or above undergoing complex revision thoracolumbar spine surgery were included. Any history of prior surgical intervention of the same vertebral level was de ned as revision surgery.…”

Section: Study Populationmentioning

confidence: 99%

“…18 Patients lacking a pre-operative CT or MRI of the lumbar spine obtained at our facility within six months of surgery, poor image quality, preoperative MRI or CT acquired at any outside facilities, clinical evidence of L1 or L2 nerve root compression, a history of previous surgical treatment to or through the psoas muscle, and coronal deformity greater than 20 degrees were excluded as mentioned in our previous study. 14…”

Section: Study Populationmentioning

confidence: 99%

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Obesity is Not Associated with Perioperative Adverse Events in Patients Undergoing Complex Revision Surgery for the Thoracolumbar Spine

Hirase¹,

Ling²,

Haghshenas³

et al. 2021

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Study Design: Retrospective cohort studyObjective: This study sought to determine the relationship between obesity and perioperative adverse events (AEs) with patients undergoing complex revision thoracolumbar spine surgery while controlling for psoas muscle index (PMI) as a confounding variable.Methods: Between May 2016 and February 2020, a retrospective analysis of individuals undergoing complex revision surgery of the thoracolumbar spine was performed at a single institution. Obesity was defined as BMI ≥ 30.0 kg/m2. PMI < 500 mm2/m2 for males and < 412 mm2/m2 for females were used to define sarcopenia. A Spine Surgical Invasiveness Index (SSII) > 10 was used to define complex revision surgery. A multivariable logistic regression model was used to ascertain the effects of sarcopenia, obesity, age, and gender on the likelihood of the occurrence of any AE.Results: The study included 114 patients. 54 patients were in the obese cohort and 60 patients in the non-obese cohort. There was not a significant difference in perioperative outcomes of both the obese and non-obese patients. Multivariable analysis demonstrated that sarcopenic individuals had a significantly higher likelihood for an AE than non-sarcopenic individuals (OR: 7.53, 95% CI: 3.05-18.60). Obesity did not have a significant effect in predicting AEs.Conclusions: Obesity is not associated with perioperative AEs, 30-day readmission rates, 30-day re-operation rates, rate of discharge to a facility, or post-operative length of stay (LOS) among patients undergoing complex revision thoracolumbar spine surgery.Level of Evidence: III

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Section: Introductionmentioning

confidence: 56%

Section: Methodsmentioning

confidence: 99%

Section: Assessment Of Sarcopeniamentioning

confidence: 99%

Section: Study Populationmentioning

confidence: 99%

Section: Study Populationmentioning

confidence: 99%

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