• Étienne Bourassa-Moreau, Anne Versteeg, Eryck Moskven, Raphaële Charest-Morin, Alana Flexman, Tamir Ailon, Turker Dalkilic, Charles Fisher, Nicolas Dea, Michael Boyd, Scott Paquette, Brian Kwon, Marcel Dvorak, and John Street.
• Hôpital du Sacré-Cœur de Montréal, 5400 Boulevard Gouin Ouest, Montréal, Québec, H4J 1C5, Canada. Electronic address: etienne.bourassamoreau@gmail.com.
• Spine J. 2020 Jan 1; 20 (1): 22-31.

Background ContextFrailty and sarcopenia variably predict adverse events (AEs) in a number of surgical populations.PurposeThe aim of this study was to investigate the ability of frailty and sarcopenia to independently predict early mortality and AEs following urgent surgery for metastatic disease of the spine.Study DesignA single institution, retrospective cohort study.Patient SampleOne hundred eight patients undergoing urgent surgery for spinal metastases from 2009 to 2015.Outcome MeasuresThe incidence of AEs including 1- and 3-month mortality.MethodsSarcopenia was defined using the L3 Total Psoas Area/Vertebral body Area (L3-TPA/VB) technique on CT. The modified Frailty Index (mFI), Metastatic Frailty Index (MSTFI) and the Bollen prognostic scales were calculated for each patient. Additional data included demographics, tumor type and burden, neurological status, the extent of surgical treatment and the use of radiation-therapy. Spearman correlation test, logistic regression and Kaplan-Meier were used to study the relation between the outcomes measures and potential predictors (L3-TPA/VB, MSTFI, mFI, and the Bollen prognostic scales).ResultsEighty-five percent of patients had at least one acute AE. Sarcopenia predicted the occurrence of at least one postop AE (L3-TPA/VB, 1.07±0.40 vs. 1.25±0.52; p=.031). Sarcopenia (L3-TPA/VB) and the degree of neurological impairment were predictive of postoperative AE but MFI or MSTFI were not. Sarcopenia predicted 3-month mortality, independent of primary tumor type (L3-TPA/VB: 0.86±0.27 vs. 1.12±0.41; p<.001). Kaplan-Meyer analysis showed L3-TPA/VB and the Bollen Scale to significantly discriminate patient survival.ConclusionsSarcopenia, easily measured by the L3-TPA/VB on conventional CT, predicts both early postoperative mortality and adverse events in patients undergoing urgent surgery for spinal metastasis, thus providing a practical tool for timely therapeutic decision-making in this complex patient population.Copyright © 2019. Published by Elsevier Inc.

26 keywords...

hide…