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Performance assessment and external validation of specific thresholds of total psoas muscle cross-sectional area as predictors of mortality in oncologic spine surgery for spinal metastases

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Abstract

Purpose

The purpose of this study was to assess the utility of low muscle mass (LMM) in predicting 90-day and 12-month mortality after spinal tumor surgery.

Methods

We identified 115 patients operated on for spinal metastases between April 2012 and August 2022 who had available perioperative abdominal or lumbar spine CT scans and minimum 90-day follow-up. LMM was defined as a total psoas muscle cross-sectional area (TPA) at the L4 pedicle level less than 10.5 cm2 for men and less than 7.2 cm2 for women based on previously reported thresholds. A secondary analysis was performed by analyzing TPA as a continuous variable. The primary endpoint was 90-day mortality, and the secondary endpoint was 12-month mortality. Multivariate logistic regression analyses were performed.

Results

The 90-day mortality was 19% for patients without and 42% for patients with LMM (p = 0.010). After multivariate analysis, LMM was not independently associated with increased odds of 90-day mortality (odds ratio 2.16 [95% confidence interval 0.62 to 7.50]; p = 0.223). The 12-month mortality was 45% for patients without and 71% for patients with LMM (p = 0.024). After multivariate analysis, LMM was not independently associated with increased odds of 12-month mortality (OR 1.64 [95% CI 0.46 to 5.86]; p = 0.442). The secondary analysis showed no independent association between TPA and 90-day or 12-month mortality.

Conclusion

Patients with LMM had higher rates of 90-day and 12-month mortality in our study, but this was not independent of other parameters such as performance status, hypoalbuminemia, or primary cancer type.

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Authors and Affiliations

  1. Spine Oncology Study Group, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA

    Rafael De la Garza Ramos, Jessica Ryvlin, Mousa K. Hamad, Benjamin Wang, Yaroslav Gelfand, Saikiran Murthy & Reza Yassari

  2. Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, 3316 Rochambeau Avenue, 3rd Floor, Bronx, NY, 10467, USA

    Rafael De la Garza Ramos, Mousa K. Hamad, Yaroslav Gelfand, Saikiran Murthy & Reza Yassari

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  1. Rafael De la Garza Ramos
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Correspondence to Rafael De la Garza Ramos.

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The authors have no competing financial or non-financial interests that are related to this work. The datasets analyzed during the current study are available from the corresponding author on reasonable request.

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De la Garza Ramos, R., Ryvlin, J., Hamad, M.K. et al. Performance assessment and external validation of specific thresholds of total psoas muscle cross-sectional area as predictors of mortality in oncologic spine surgery for spinal metastases. Eur Spine J 32, 1003–1009 (2023). https://doi.org/10.1007/s00586-022-07517-z

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