Is Sarcopenia a Risk Factor for Postoperative Surgical Site Infection After Posterior Lumbar Spinal Fusion?

Francesca Barile; Alberto Ruffilli; Michele Fiore; Marco Manzetti; Giuseppe Geraci; Giovanni Viroli; Cesare Faldini

doi:10.14444/8302

Is Sarcopenia a Risk Factor for Postoperative Surgical Site Infection After Posterior Lumbar Spinal Fusion?

Int J Spine Surg. 2022 Jul 14;16(4):735-739. doi: 10.14444/8302. Online ahead of print.

Authors

Francesca Barile¹, Alberto Ruffilli¹, Michele Fiore², Marco Manzetti¹, Giuseppe Geraci¹, Giovanni Viroli¹, Cesare Faldini¹

Affiliations

¹ First Orthopaedic and Traumatologic Clinic - IRCCS Istituto Ortopedico Rizzoli (IOR), Bologna, Italy.
² First Orthopaedic and Traumatologic Clinic - IRCCS Istituto Ortopedico Rizzoli (IOR), Bologna, Italy michele.fiore@ior.it.

PMID: 35835577
PMCID: PMC9421281
DOI: 10.14444/8302

Abstract

Background: This retrospective observational study aimed to evaluate the impact of sarcopenia on surgical site infection (SSI) risk in patients who undergo posterior lumbar fusion. While many studies have investigated the impact of sarcopenia on postoperative morbidity both in general and orthopedic surgery, none of them examined the risk of postoperative infection after lumbar spine surgery in sarcopenic vs nonsarcopenic patients.

Methods: Consecutive 55- to 75-year-old patients who underwent short posterior lumbar fusion for degenerative pathology between 2004 and 2019 were included. Charts were reviewed, and the psoas:lumbar vertebral index (PLVI) was used as a measure of central sarcopenia. Patients were stratified according to low vs high PLVI and then according to postoperative infection status. SSI was assessed as an outcome. A statistical analysis was performed to identify risk factors for infection.

Results: A total of 304 patients were included; 24 (7.9%) developed postoperative SSI. The average follow-up was 26.2 months. The sarcopenic group was found to not have a higher likelihood of experiencing postoperative SSI (P = 0.947). Only Charlson Comorbidity Index and American Society of Anesthesiology score were significantly associated with infectious complications (P = 0.008 and P = 0.017, respectively).

Conclusions: Low PLVI was not associated with postoperative SSI in this study. This finding is in contrast with the findings of other authors who found sarcopenia to be a risk factor for postoperative complications. However, these studies did not consider SSI as the only primary endpoint, and patients were not stratified by indication (degeneration, infection, tumor, and trauma) or surgical procedure.

Clinical relevance: Low PLVI was not associated with postoperative SSI in patients who undergo short posterior lumbar fusion for degenerative pathology.

Keywords: infection risk; lumbar degenerative disease; lumbar fusion; sarcopenia; surgical site infection.

This manuscript is generously published free of charge by ISASS, the International Society for the Advancement of Spine Surgery. Copyright © 2022 ISASS. To see more or order reprints or permissions, see http://ijssurgery.com.