title: Morphometrics as a predictor of perioperative morbidity after lumbar spine surgery.
abstract: OBJECT Improved objective assessments of perioperative risk after spine surgery are necessary to decrease postoperative morbidity and mortality rates. Morphometric analysis has proven utility in predicting postoperative morbidity and mortality in surgical disciplines. The aim of the present study was to evaluate whether morphometrics can be applied to the cases of patients undergoing lumbar spine surgery. METHODS The authors performed a retrospective review of the perioperative course of 395 patients who underwent lumbar surgery at their institution from 2013 to 2014. Preoperative risk factors such as age, diabetes, smoking, coronary artery disease, and body mass index (BMI) were recorded. Preoperative MRI was used to measure the psoas muscle area at the L-4 vertebra and paraspinal muscle area at the T-12 vertebra. Primary outcomes included unplanned return to the operating room, 30- and 90-day readmissions, surgical site infection, wound dehiscence, new neurological deficit, deep vein thrombosis, pulmonary embolism, myocardial infarction, urinary tract infection, urinary retention, hospital-acquired pneumonia, stroke, and prolonged stay in the intensive care unit. RESULTS The overall rate of adverse events was 30%, the most common event being urinary retention (12%). Greater age (p = 0.015) and tobacco usage (p = 0.026) were both significantly associated with complications for all patients, while diabetes, coronary artery disease, and high BMI were not. No surgery-related characteristics were associated with postoperative morbidity, including whether surgery required instrumentation, whether it was a revision, or the number of vertebral levels treated. Using multivariate regression analysis, male and female patients with the lowest psoas tertile had an OR of 1.70 (95% CI 1.04-2.79, p = 0.035) for having postoperative complications. Male patients in the lowest psoas tertile had an OR of 2.42 (95% CI 1.17-5.01, p = 0.016) for having a postoperative complication. The paraspinal muscle groups did not provide any significant data for postoperative morbidity, even after multivariate analysis. CONCLUSIONS The morphometric measurement of psoas muscle size may be a sensitive predictive tool compared with other risk factors for perioperative morbidity in male patients undergoing lumbar surgery.
authors.affiliation: Departments of 1 Neurosurgery.
authors.forename: Hesham Mostafa
authors.initials: HM
authors.lastname: Zakaria
authors.affiliation: Public Health Sciences, and.
authors.forename: Lonni
authors.initials: L
authors.lastname: Schultz
authors.affiliation: Radiology, Neuroscience Institute, Henry Ford Health System, Detroit, Michigan.
authors.forename: Feras
authors.initials: F
authors.lastname: Mossa-Basha
authors.affiliation: Radiology, Neuroscience Institute, Henry Ford Health System, Detroit, Michigan.
authors.forename: Brent
authors.initials: B
authors.lastname: Griffith
authors.affiliation: Departments of 1 Neurosurgery.
authors.forename: Victor
authors.initials: V
authors.lastname: Chang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007902:Length of Stay; D008159:Lumbar Vertebrae / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D012307:Risk Factors; D013118:Spinal Cord Diseases / Q000601:surgery*; D013530:Surgical Wound Infection / Q000453:epidemiology* / Q000209:etiology*; D055815:Young Adult
keywords: BMI = body mass index; CAD = coronary artery disease; DVT = deep vein thrombosis; HFHS = Henry Ford Health System; ICC = intraclass correlation coefficient; LOS = length of stay; Ml = myocardial infarction; PE = pulmonary embolism; UTI = urinary tract infection; frailty index; lumbar spine complications; morphometrics