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Comparison of Sarcopenia With Frailty and Area Deprivation Index for Predicting Postoperative Mortality and
Brian M Shear1, Anthony K Chiu, Adam Stombler
1Department of Orthopaedics, Division of Spine Surgery, University of Maryland Medical Center, Baltimore, MD.
Study Design:
Retrospective analysis.
Objective:
To compare sarcopenia to frailty and socioeconomic deprivation as preoperative predictors of mortality and complications in thoracolumbar spine trauma.
Summary Of Background Data:
Sarcopenia is a progressive musculoskeletal disorder characterized by the loss of muscle mass and function. Recently, it has gained recognition as an important surgical risk factor. Prior studies have demonstrated its association with adverse outcomes in spine surgery for degenerative, deformity, and neoplastic indications. Currently, there is a dearth of literature investigating the role of sarcopenia in thoracolumbar trauma.
Methods:
Adult patients undergoing instrumentation and stabilization of thoracolumbar spine trauma were identified at an urban academic level-1 trauma center. Sarcopenia was measured using the L3 total psoas area over vertebral body area (L3-TPA/VBA) measured from perioperative computed tomography (CT) scans. Area deprivation index (ADI) was determined according to the publicly available Neighborhood Atlas data set. Frailty was measured using the modified 5-factor frailty index (mFI-5). Statistical analysis consisted of Pearson χ 2 tests, univariate logistic regression, determination of Spearman correlation coefficient ( rs ), and multivariable logistic regression controlling for demographics and polytraumatic injuries.
Results:
A total of 276 patients were included. A total of 22 mortalities occurred (7.7%), with 18 (6.3%) occurring within 90-days postoperatively. On univariate analysis, only the mFI-5 scale was associated with 1-month (OR=2.42, P <0.001), 3-month (OR=2.61, P <0.001), and overall mortality (OR=2.29, P <0.001). On multivariate analysis, none of the sarcopenia, ADI, or mFI-5 were independently associated with mortality, the occurrence of postoperative complications, or revision.
Conclusions:
Frailty is a better predictor of mortality in thoracolumbar trauma when compared with sarcopenia and ADI. However, an mFI threshold of 2+ may act synergistically with sarcopenia to increase mortality rates.
Level Of Evidence:
Level III.
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