Malnutrition Predicts Infectious and Wound Complications Following Posterior Lumbar Spinal Fusion

Bohl, Daniel D.; Shen, Mary R.; Mayo, Benjamin C.; Massel, Dustin H.; Long, William W.; Modi, Krishna; Basques, Bryce A.; Singh, Kern

doi:10.1097/brs.0000000000001591

Cited by 124 publications

(114 citation statements)

References 27 publications

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“…The current study con rmed that perioperative hypoalbunemia was an important risk factors for wound complications following single-segment PLIF surgery [22][23][24][25][26][27]. Our study further con rmed that perioperative hypoalbuminemia are important risk factors for SWD and SSI.…”

Section: Discussionsupporting

confidence: 76%

“…Similarly, they retrospectively reviewed data prospectively collected by the American College of Surgeons National Surgical Quality Improvement Program to investigate the relationship between preoperative hypoalbuminemia and complications after 30 days of posterior lumbar fusion. They pointed out that malnutrition was an independent risk factor for infection and wound complications after posterior lumbar fusion, and it was also associated with increased length of stay and readmission [31].…”

Section: Discussionmentioning

confidence: 99%

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Perioperative Hypoalbuminemia is a Risk Factor for Wound Complications Following Posterior Lumbar Interbody Fusion

Zhou

Tang

et al. 2020

Preprint

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Background: Although serum albumin levels are increasingly used as an indicator of nutritional status in the clinic, the relationship between perioperative hypoalbuminemia and wound complications after posterior lumbar interbody fusion in the treatment of lumbar degenerative disease remains ambiguous. The aim of this study was to evaluate perioperative serum albumin in relation to postoperative wound complications after posterior lumbar interbody fusion in the treatment of single-segment lumbar degenerative disease. Material and methods: We reviewed patients who underwent single-segment posterior lumbar interbody fusion surgery from December 2014 to April 2017 in the Department of Orthopedics at the First Affiliated Hospital of Chongqing Medical University. Perioperative (preoperative and early postoperative) serum albumin levels were assessed in all patients and were used to quantify nutritional status. We divided the patients into a surgical wound dehiscence (SWD) group and a normal wound healing group, and into a surgical site infection (SSI) group and a non-SSI group. To evaluate the relationship between perioperative serum albumin level and postoperative wound complications, we conducted univariate and multiple logistic regression analyses.Results: A total of 554 patients were enrolled in the study. The univariate and multiple logistic regression analysis of these differences showed that preoperative serum albumin <3.5 g/dl (P =0.001) and postoperative serum albumin <3.0 g/dl (P =0.001) were significantly correlated to SWD. There were also significant differences between the SSI groups in terms of preoperative serum albumin <3.5 g/dl (P=0.001), Chronic steroid use (P=0.003). Additionally, the increased hospitalization costs (P<0.001) and length of hospitalization (P<0.001) were statistically significant for patients with perioperative hypoalbuminemia. Conclusions: For patients who underwent single-segment posterior lumbar interbody fusion surgery, we need to pay more attention to perioperative hypoalbuminemia and chronic steroid use,which are more likely to be associated with increased wound complications, hospitalization costs and length of hospitalization after surgery. Adequate assessment and management of these risk factors will help reduce wound complications and hospital stays for surgical patients and will save medical costs.

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Section: Discussionsupporting

confidence: 76%

Section: Discussionmentioning

confidence: 99%

Perioperative Hypoalbuminemia is a Risk Factor for Wound Complications Following Posterior Lumbar Interbody Fusion

Zhou

Tang

et al. 2020

Preprint

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“…18,19 Therefore, patients with preoperative hypoalbuminemia have a higher risk of complications related to the healing of the surgical wound. 1,3,15,20 This study, however, found no significant correlation between preoperative hypoalbuminemia and the rates of postoperative infection or of complications in the wound-healing process. Some authors affirm that albumin should not be used as a standalone criterion for the nutritional assessment of patients, and that it should be associated with other nutritional indicators, such as anthropometry and body composition.…”

Section: Discussionmentioning

confidence: 42%

Correlation Between Nutritional Status and Clinical Results in Patients Undergoing Spinal Surgery

et al. 2017

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Objective: To investigate the relationship between preoperative vitamin D and albumin levels and postoperative quality of life in patients undergoing spinal surgery. Methods: Patients undergoing thoracic and lumbar spine surgery were evaluated in this prospective study. Their vitamin D and albumin levels were assessed before surgery and quality of life was measured by two questionnaires, Oswestry Disability Index (ODI) and Scoliosis Research , one year after the procedure. Data on infection occurrence and healing time were collected. Preoperative nutritional values and patients' quality of life were analyzed using the chi-square test and ANOVA for albumin and vitamin D, respectively. The relationship among nutritional status, healing time, and the occurrence of infection was evaluated by the Pearson correlation coefficient. Results: Forty-six patients were included and their mean nutritional values were 19.1 (6.6) ng/mL for vitamin D and 3.9 (0.6) g/dL for albumin [mean (standard deviation)]. No association was found between vitamin D and quality of life of patients measured by ODI (p=0.534) and SRS-22 (p=0.739) questionnaires. There was also no association between albumin levels and quality of life measured by ODI (p=0.259) and SRS-22 (p=0.076) questionnaires. No correlation was found between the healing time or occurrence of infection and nutritional values. Conclusions: There was no association between vitamin D and albumin levels and the surgical result, according to the patient's perception, besides the occurrence of complications with the surgical wound.Keywords: Spine; Serum albumin; Vitamin D; Surgical wound infection; Quality of life. 19,1 (6,6) ng/ml para vitamina D e 3,9 (0,6) g/dl para albumina [média (desvio-padrão)]. Não foi encontrada associação entre os níveis de vitamina D e qualidade de vida dos pacientes medidos pelos questionários ODI (p = 0,739). Também não houve associação entre níveis de albumina e qualidade de vida medidos pelos questionários ODI (p = 0,076 ODI (p = 0,739). También no hubo asociación entre los niveles de albúmina y la calidad de vida medidos por los cuestionarios ODI (p = 0,076) RESUMO Objetivo: Investigar a relação entre os níveis de vitamina D e albumina pré-operatórios e qualidade de vida pós-operatória em pacientes submetidos a cirurgia de coluna. Métodos: Pacientes submetidos a cirurgia de coluna nos níveis torácico e lombar foram avaliados neste estudo prospectivo. Seus níveis de vitamina D e albumina foram avaliados antes da cirurgia e a qualidade de vida foi medida por meio de dois questionários, Oswestry Disability Index (ODI) e Scoliosis Research Society -22 (SRS-22), um ano após o procedimento. Os dados sobre ocorrência de infecção e tempo de cicatrização foram coletados. Os valores nutricionais pré-operatórios e a qualidade de vida dos pacientes foram analisados usando o teste de qui-quadrado e ANOVA para albumina e vitamina D, respectivamente. A relação entre o estado nutricional e o tempo de cicatrização e a ocorrência de infecção foram avaliados pelo coe...

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“…Therefore, it can minimises protein loss, improve patient comfort and decrease insulin resistance (21). Good nutritional status could reduce the occurrence of complications such as wound infections and may help wound healing (22). Research examining shortening preoperative fasting and postoperative eating time of elderly patients with lumbar surgery is markedly lacking, despite studies indicating that it is safe and effective (1,18,23).…”

Section: Discussionmentioning

confidence: 99%

Enhanced recovery after surgery (ERAS) program for elderly patients with short-level lumbar fusion

Wang

Kong

et al. 2020

Preprint

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Background: Degenerative disorders of the lumbar spine decrease the mobility and quality of life of elderly patients. Lumbar fusion surgery is the primary method of treating degenerative lumbar spine disorders; however, the surgical stress response associated with major surgery has been linked to pathophysiological changes in the elderly, resulting in undesirable postoperative morbidity, complications, pain, fatigue, and extended convalescence. In the present study, we aimed to determine whether enhanced recovery after surgery significantly improved satisfaction and outcomes in elderly patients (>65 years old) with short-level lumbar fusion. Methods: A total of 192 patients were included, 96 in the enhanced recovery after surgery group and 96 case-matched patients in the non- enhanced recovery after surgery group. Data including demographic, comorbidity and surgical information were collected from electronic medical records. enhanced recovery after surgery interventions were categorised as preoperative, intraoperative and postoperative. We also evaluated primary outcome, surgical complication, length of stay, postoperative pain scores and 30-day readmission rates. Results: There were no statistically significant intergroup differences in regards to demographics, comorbidities、American Society of Anaesthesiologists grade、or the number of fusion levels. There were also no differences between mean surgery time of intraoperative blood loss between the enhanced recovery after surgery and non- enhanced recovery after surgery groups. In addition, the mean preoperative Japanese Orthopaedic Association score、Visual Analogue Score for the back and legs and Oswestry Disability Index score were not significantly different between the two groups. Overall, enhanced recovery after surgery pathway compliance was 92.1%. There were no significant differences in the number of complications or the mortality rates between the enhanced recovery after surgery and non- enhanced recovery after surgery groups. Furthermore, the mean postoperative Japanese Orthopaedic Association score、Visual Analogue Score for the back and legs, Oswestry Disability Index score and readmission rates score revealed no significant differences between the groups at 30-day- follow-up point. However, we observed a statistically significant decrease in length of stay in the enhanced recovery after surgery group (12.30±3.03 of enhanced recovery after surgery group versus 15.50±1.88 in non- enhanced recovery after surgery group, p=0). Multivariable linear regression showed that comorbidities (p=0.023) and implementation of enhanced recovery after surgery program (p=0.002) were correlated with prolonged length of stay. Multivariable logistic regression showed that no characteristics were associated with complications. Conclusions: This report describes the first enhanced recovery after surgery protocol used in elderly patients after short-level lumbar fusion surgery. Our enhanced recovery after surgery program is safe and could help decreases length of stay in elderly patients with short-level lumbar fusion.

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Malnutrition Predicts Infectious and Wound Complications Following Posterior Lumbar Spinal Fusion

Abstract: 3.

Cited by 124 publications

References 27 publications

Perioperative Hypoalbuminemia is a Risk Factor for Wound Complications Following Posterior Lumbar Interbody Fusion

Perioperative Hypoalbuminemia is a Risk Factor for Wound Complications Following Posterior Lumbar Interbody Fusion

Correlation Between Nutritional Status and Clinical Results in Patients Undergoing Spinal Surgery

Enhanced recovery after surgery (ERAS) program for elderly patients with short-level lumbar fusion

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