Journal of Korean Neurosurgical Society

  • 제64권6호
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  • Pages.995-1003
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  • 2021
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  • 2005-3711(pISSN)
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  • 1598-7876(eISSN)
대한신경외과학회 (The Korean Neurosurgical Society)
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Central Sarcopenia, Frailty and Comorbidity as Predictor of Surgical Outcome in Elderly Patients with Degenerative Spine Disease

  • Kim, Dong Uk (Department of Neurosurgery, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine) ;
  • Park, Hyung Ki (Department of Neurosurgery, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine) ;
  • Lee, Gyeoung Hae (Department of Neurosurgery, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine) ;
  • Chang, Jae Chil (Department of Neurosurgery, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine) ;
  • Park, Hye Ran (Department of Neurosurgery, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine) ;
  • Park, Sukh Que (Department of Neurosurgery, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine) ;
  • Cho, Sung Jin (Department of Neurosurgery, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine)
  • 투고 : 2021.03.30
  • 심사 : 2021.07.10
  • 발행 : 2021.11.01
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초록

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.

키워드

과제정보

This work was supported by the Soonchunhyang University Research Fund.

참고문헌

  1. Agarwal N, Goldschmidt E, Taylor T, Roy S, Dunn SCA, Bilderback A, et al. : Impact of frailty on outcomes following spine surgery: a prospective cohort analysis of 668 patients. Neurosurgery 88 : 552-557, 2021 https://doi.org/10.1093/neuros/nyaa468
  2. Balsam LB : Psoas muscle area: a new standard for frailty assessment in cardiac surgery? J Thorac Dis 10(Suppl 33) : S3846-S3849, 2018 https://doi.org/10.21037/jtd.2018.10.96
  3. Camino Willhuber G, Elizondo C, Slullitel P : Analysis of postoperative complications in spinal surgery, hospital length of stay, and unplanned readmission: application of Dindo-Clavien classification to spine surgery. Global Spine J 9 : 279-286, 2019 https://doi.org/10.1177/2192568218792053
  4. Cesari M, Calvani R, Marzetti E : Frailty in older persons. Clin Geriatr Med 33 : 293-303, 2017 https://doi.org/10.1016/j.cger.2017.02.002
  5. Chang SY, Son J, Park SM, Chang BS, Lee CK, Kim H : Predictive value of comprehensive geriatric assessment on early postoperative complications following lumbar spinal stenosis surgery: a prospective cohort study. Spine (Phila Pa 1976) 45 : 1498-1505, 2020 https://doi.org/10.1097/BRS.0000000000003597
  6. Charest-Morin R, Street J, Zhang H, Roughead T, Ailon T, Boyd M, et al. : Frailty and sarcopenia do not predict adverse events in an elderly population undergoing non-complex primary elective surgery for degenerative conditions of the lumbar spine. Spine J 18 : 245-254, 2018 https://doi.org/10.1016/j.spinee.2017.07.003
  7. Charlson M, Szatrowski TP, Peterson J, Gold J : Validation of a combined comorbidity index. J Clin Epidemiol 47 : 1245-1251, 1994 https://doi.org/10.1016/0895-4356(94)90129-5
  8. Charlson ME, Pompei P, Ales KL, MacKenzie CR : A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40 : 373-383, 1987 https://doi.org/10.1016/0021-9681(87)90171-8
  9. Cizik AM, Lee MJ, Martin BI, Bransford RJ, Bellabarba C, Chapman JR, et al. : Using the spine surgical invasiveness index to identify risk of surgical site infection: a multivariate analysis. J Bone Joint Surg Am 94 : 335-342, 2012 https://doi.org/10.2106/JBJS.J.01084
  10. Cruz-Jentoft AJ, Bahat G, Bauer J, Boirie Y, Bruyere O, Cederholm T, et al. : Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing 48 : 16-31, 2019 https://doi.org/10.1093/ageing/afy169
  11. Cruz-Jentoft AJ, Sayer AA : Sarcopenia. Lancet 393 : 2636-2646, 2019 https://doi.org/10.1016/s0140-6736(19)31138-9
  12. Dagistan Y, Dagistan E, Gezici AR, Cancan SE, Bilgi M, Cakir U : Effects of minimally invasive decompression surgery on quality of life in older patients with spinal stenosis. Clin Neurol Neurosurg 139 : 86-90, 2015 https://doi.org/10.1016/j.clineuro.2015.09.009
  13. Deyo RA, Mirza SK, Martin BI, Kreuter W, Goodman DC, Jarvik JG : Trends, major medical complications, and charges associated with surgery for lumbar spinal stenosis in older adults. JAMA 303 : 1259-1265, 2010 https://doi.org/10.1001/jama.2010.338
  14. Dhillon RJ, Hasni S : Pathogenesis and management of sarcopenia. Clin Geriatr Med 33 : 17-26, 2017 https://doi.org/10.1016/j.cger.2016.08.002
  15. Ebbeling L, Grabo DJ, Shashaty M, Dua R, Sonnad SS, Sims CA, et al. : Psoas:lumbar vertebra index: central sarcopenia independently predicts morbidity in elderly trauma patients. Eur J Trauma Emerg Surg 40 : 57-65, 2014 https://doi.org/10.1007/s00068-013-0313-3
  16. Gibbons D, Ahern DP, Curley AE, Kepler CK, Butler JS : Impact of sarcopenia on degenerative lumbar spondylosis. Clin Spine Surg 34 : 43-50, 2021 https://doi.org/10.1097/BSD.0000000000001047
  17. Hannah TC, Neifert SN, Caridi JM, Martini ML, Lamb C, Rothrock RJ, et al. : Utility of the hospital frailty risk score for predicting adverse outcomes in degenerative spine surgery cohorts. Neurosurgery 87 : 1223-1230, 2020 https://doi.org/10.1093/neuros/nyaa248
  18. Indrakusuma R, Zijlmans JL, Jalalzadeh H, Planken RN, Balm R, Koelemay MJW : Psoas muscle area as a prognostic factor for survival in patients with an asymptomatic infrarenal abdominal aortic aneurysm: a retrospective cohort study. Eur J Vasc Endovasc Surg 55 : 83-91, 2018 https://doi.org/10.1016/j.ejvs.2017.10.007
  19. Jain A, Hassanzadeh H, Puvanesarajah V, Klineberg EO, Sciubba DM, Kelly MP, et al. : Incidence of perioperative medical complications and mortality among elderly patients undergoing surgery for spinal deformity: analysis of 3519 patients. J Neurosurg Spine 27 : 534-539, 2017 https://doi.org/10.3171/2017.3.SPINE161011
  20. Jang HJ, Chin DK, Park JY, Kuh SU, Kim KS, Cho YE, et al. : Influence of frailty on life expectancy in octogenarians after lumbar spine surgery. Neurospine 18 : 303-310, 2021 https://doi.org/10.14245/ns.2040688.344
  21. Jung HW, Yoo HJ, Park SY, Kim SW, Choi JY, Yoon SJ, et al. : The Korean version of the FRAIL scale: clinical feasibility and validity of assessing the frailty status of Korean elderly. Korean J Intern Med 31 : 594-600, 2016 https://doi.org/10.3904/kjim.2014.331
  22. Kang T, Park SY, Lee JS, Lee SH, Park JH, Suh SW : Predicting postoperative complications in patients undergoing lumbar spinal fusion by using the modified five-item frailty index and nutritional status. Bone Joint J 102-B : 1717-1722, 2020 https://doi.org/10.1302/0301-620X.102B12.BJJ-2020-0874.R1
  23. Kim JY, Park IS, Kang DH, Lee YS, Kim KT, Hong SJ : Prediction of risk factors after spine surgery in patients aged >75 years using the modified frailty index. J Korean Neurosurg Soc 63 : 827-833, 2020 https://doi.org/10.3340/jkns.2020.0019
  24. Kleczynski P, Tokarek T, Dziewierz A, Sorysz D, Bagienski M, Rzeszutko L, et al. : Usefulness of psoas muscle area and volume and frailty scoring to predict outcomes after transcatheter aortic valve implantation. Am J Cardiol 122 : 135-140, 2018 https://doi.org/10.1016/j.amjcard.2018.03.020
  25. Kobayashi K, Imagama S, Sato K, Kato F, Kanemura T, Yoshihara H, et al. : Postoperative complications associated with spine surgery in patients older than 90 years: a multicenter retrospective study. Global Spine J 8 : 887-891, 2018 https://doi.org/10.1177/2192568218767430
  26. Kweh B, Lee H, Tan T, O'Donohoe T, Mathew J, Fitzgerald M, et al. : Spinal surgery in patients aged 80 years and older: risk stratification using the modified frailty index. Global Spine J 11 : 525-532, 2021 https://doi.org/10.1177/2192568220914877
  27. Mannion AF, Bianchi G, Mariaux F, Fekete TF, Reitmeir R, Moser B, et al. : Can the Charlson Comorbidity Index be used to predict the ASA grade in patients undergoing spine surgery? Eur Spine J 29 : 2941-2952, 2020 https://doi.org/10.1007/s00586-020-06595-1
  28. Matsuo S, Kawakami M, Minetama M, Nakagawa M, Teraguchi M, Kagotani R, et al. : Clinical features of sarcopenia in patients with lumbar spinal stenosis. Spine (Phila Pa 1976) 45 : E1105-E1110, 2020 https://doi.org/10.1097/BRS.0000000000003498
  29. Morley JE, Malmstrom TK, Miller DK : A simple frailty questionnaire (FRAIL) predicts outcomes in middle aged African Americans. J Nutr Health Aging 16 : 601-608, 2012 https://doi.org/10.1007/s12603-012-0084-2
  30. Paknikar R, Friedman J, Cron D, Deeb GM, Chetcuti S, Grossman PM, et al. : Psoas muscle size as a frailty measure for open and transcatheter aortic valve replacement. J Thorac Cardiovasc Surg 151 : 745-751, 2016 https://doi.org/10.1016/j.jtcvs.2015.11.022
  31. Rodriguez-Manas L, Feart C, Mann G, Vina J, Chatterji S, Chodzko-Zajko W, et al. : Searching for an operational definition of frailty: a Delphi method based consensus statement: the frailty operative definition-consensus conference project. J Gerontol A Biol Sci Med Sci 68 : 62-67, 2013 https://doi.org/10.1093/gerona/gls119
  32. Roffman CE, Buchanan J, Allison GT : Charlson comorbidities index. J Physiother 62 : 171, 2016 https://doi.org/10.1016/j.jphys.2016.05.008
  33. Segal DN, Wilson JM, Staley C, Michael KW : The 5-item modified frailty index is predictive of 30-day postoperative complications in patients undergoing kyphoplasty vertebral augmentation. World Neurosurg 116 : e225-e231, 2018 https://doi.org/10.1016/j.wneu.2018.04.172
  34. Shen W, Punyanitya M, Wang Z, Gallagher D, St-Onge MP, Albu J, et al. : Total body skeletal muscle and adipose tissue volumes: estimation from a single abdominal cross-sectional image. J Appl Physiol (1985) 97 : 2333-2338, 2004 https://doi.org/10.1152/japplphysiol.00744.2004
  35. Simcox T, Antoku D, Jain N, Acosta F, Hah R : Frailty syndrome and the use of frailty indices as a preoperative risk stratification tool in spine surgery: a review. Asian Spine J 13 : 861-873, 2019 https://doi.org/10.31616/asj.2018.0239
  36. Watanabe T, Kanayama M, Takahata M, Oda I, Suda K, Abe Y, et al. : Perioperative complications of spine surgery in patients 80 years of age or older: a multicenter prospective cohort study. J Neurosurg Spine 32 : 554-558, 2020 https://doi.org/10.3171/2019.9.SPINE19961
  37. Yoo JI, Ha YC : Review of epidemiology, diagnosis, and treatment of osteosarcopenia in Korea. J Bone Metab 25 : 1-7, 2018 https://doi.org/10.11005/jbm.2018.25.1.1
  38. Zileli M, Dursun E : How to improve outcomes of spine surgery in geriatric patients. World Neurosurg 140 : 519-526, 2020 https://doi.org/10.1016/j.wneu.2020.04.060
  39. Zuckerman J, Ades M, Mullie L, Trnkus A, Morin JF, Langlois Y, et al. : Psoas muscle area and length of stay in older adults undergoing cardiac operations. Ann Thorac Surg 103 : 1498-1504, 2017 https://doi.org/10.1016/j.athoracsur.2016.09.005