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.