Nutritional Insufficiency as a Predictor for Adverse Outcomes in Adult Spinal Deformity Surgery

Phan, Kevin; Kim, Jun; Xu, Joshua; Capua, John Di; Lee, Nathan J.; Kothari, Parth; Vig, Khushdeep S.; Dowdell, James; Cho, Samuel K.

doi:10.1177/2192568217708777

Cited by 33 publications

(25 citation statements)

References 44 publications

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“…3,012 articles underwent title and abstract screening and 31 studies were selected for full-text review. 18 studies were excluded with reasons and 13 were included in the review (10)(11)(12)(13)(14)(15)(18)(19)(20)(21)(22)(23)(24).…”

Section: Resultsmentioning

confidence: 99%

Association between hypoalbuminemia and complications after degenerative and deformity-correcting spinal surgeries: A systematic review and meta-analysis

Huang

et al. 2023

Front. Surg.

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ObjectiveThe current review was designed to explore if hypoalbuminemia is associated with increased complications in patients undergoing spinal degenerative and deformities surgeries.MethodsThe search for eligible studies was conducted on the databases of PubMed, Embase, Web of Science, and CENTRAL up to 20th June 2022. Complication rates were pooled to obtain odds ratio (OR) and 95% confidence intervals.ResultsThirteen studies were included. We found that hypoalbuminemia was significantly associated with increased risk of all complications (OR: 2.72 95% CI: 2.04, 3.63 I2 = 58% p < 0.00001), mortality (OR: 7.73 95% CI: 3.81, 15.72 I2 = 0% p < 0.00001), revision surgery (OR: 3.15 95% CI: 1.53, 6.48 I2 = 87% p = 0.002), readmissions (OR: 1.96 95% CI: 1.29, 2.98 I2 = 23% p = 0.02), surgical site infections (OR: 2.97 95% CI: 1.90, 4.63 I2 = 38% p < 0.00001), wound complications (OR: 2.31 95% CI: 1.17, 4.56 I2 = 48% p = 0.02), pulmonary complications (OR: 3.74 95% CI: 2.66, 5.26 I2 = 0% p < 0.00001), renal complications (OR: 3.04 95% CI: 1.22, 7.54 I2 = 0% p = 0.02), cardiac complications (OR: 4.33 95% CI: 2.14, 8.77 I2 = 0% p < 0.0001), urinary tract infections (OR: 2.08 95% CI: 1.80, 2.41 I2 = 0% p < 0.00001), and sepsis (OR: 4.95 95% CI: 1.87, 13.08 I2 = 64% p = 0.01) as compared to those with normal albumin.ConclusionHypoalbuminemia is a significant risk factor for complications after spinal degenerative and deformity surgeries. Research is also needed on the role of nutritional support in improving outcomes after spinal degenerative and deformity surgeries.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/, identifier: CRD42022340024.

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Section: Resultsmentioning

confidence: 99%

Association between hypoalbuminemia and complications after degenerative and deformity-correcting spinal surgeries: A systematic review and meta-analysis

Huang

et al. 2023

Front. Surg.

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“…12 In a study on adult lumbar deformity surgeries using the National Surgical Quality Improvement Program (NSQIP) database, hypoalbuminemia showed to be a risk factor for mortality, increased length of stay, any complications, and 30-day mortality. 13 On the other hand, a single institution study demonstrated that a low preoperative albumin level may be a risk factor for surgical site infections (SSI) in spine surgeries overall, but it was not seen to be statistically significant. 14 Additionally, a retrospective analysis of patients undergoing PLIF in the NSQIP database did not find low serum albumin to be a significant predictor of postoperative complications.…”

Section: Introductionmentioning

confidence: 99%

Hypoalbuminemia and Elevated CRP are Risk Factors for Deep Infections and Urinary Tract Infections After Lumbar Spine Surgery in a Large Retrospective Patient Population

Yoshida

Nguyen

Formanek

et al. 2021

Global Spine Journal

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Study Design: Retrospective cross-sectional study. Objectives: To determine if pre-operative albumin and CRP can predict post-operative infections after lumbar surgery. Methods: Patients who underwent an anterior lumbar interbody fusion (ALIF), posterior lumbar interbody fusion (PLIF), or lumbar discectomy were identified using a patient record database (PearlDiver) and were included in this retrospective study. Patients were stratified by Charlson Comorbidity Index (CCI) scores and pre-operative albumin and CRP status. Post-operative complications included deep infections and urinary tract infections within 3 months of the surgery and revisions within 1 year of the surgery. Results: 74,280 patients were included in this study. 21,903 had pre-operative albumin or CRP lab values. 7,191 (33%), 12,183 (56%), and 2,529 (12%) patients underwent an ALIF, PLIF, and a lumbar discectomy, respectively. 16,191 did not have any complication (74%). The most common complication was UTI (16%). Among all patients, hypoalbuminemia was a significant risk factor for deep infection and UTI after ALIF, deep infection, UTI, and surgical revision after PLIF, and deep infection after lumbar discectomy. Elevated CRP was a significant risk factor for deep infection after ALIF, UTI after PLIF, and deep infection after lumbar discectomy in patients with a CCI ≤ 3. Conclusions: Pre-operative hypoalbuminemia and elevated CRP were significant risk factors for deep infection, UTI, and/or revision, after ALIF, PLIT, and/or lumbar discectomy. Future studies with a larger population of patients with low albumin and high CRP values are needed to further elaborate on the current findings.

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“…However, while past literature has identified patients at risk for extended LOS, there is little research on determinants of short LOS after ASD surgery. Given that most studies have defined extended LOS as either >75th percentile or an arbitrary value of greater than 5 days, [15][16][17][18] historically identified factors may not be applicable to the creation of expedited care pathways. Furthermore, very few studies have reported on the relationship between LOS and process components of the hospital course, such as mobilization protocols or the intraoperative details of surgery (such as blood loss, length of surgery, or levels of fusion), modifiable factors that show promise in reducing LOS.…”

Section: Introductionmentioning

confidence: 99%

Factors Associated With Short Length of Stay After Long Fusions for Adult Spinal Deformity: Initial Steps Toward Developing an Enhanced Recovery Pathway

Lovecchio

Steinhaus

Elysée

et al. 2020

Global Spine Journal

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Study Design: Retrospective cohort study. Objectives: The identification of case types and institutional factors associated with reduced length of stay (LOS) is a key initial step to inform the creation of clinical care pathways that can assist hospitals to maximize the benefit of value-based payment models. The objective of this study was to identify preoperative, intraoperative, and postoperative factors associated with shorter than expected LOS after adult spinal deformity (ASD) surgery. Methods: A retrospective cohort study was performed of 82 patients with ASD who underwent ≥5 levels of fusion to the pelvis between 2013 and 2018. A LOS <6 days was determined as a basis for comparison, as 5.7 days was the “expected LOS” generated through Poisson regression modeling of the sample. Clinical, radiographic, surgical, and postoperative factors were compared between those staying ≥6 days (L group) and <6 days (S group). Logistic regression was used to identify factors associated with LOS <6 days. Results: A total of 35 patients were in group S (42.7%). Gender, age, body mass index, ASA (American Society of Anesthesiologists) class, and use of preoperative narcotics, revision surgery, day of admission, and surgical complications did not vary between the cohorts ( P > .05). Mild-moderate preoperative sagittal deformity (sagittal Schwab modifiers 0 or +), lower estimated blood loss (<1200 mL), fewer levels fused (7 vs 10 levels), shorter operating room time, procedure end time before 15:00, and no intensive care unit stay, were associated with short LOS ( P < .05). Only 1 major medical complication occurred in the short LOS group ( P < .05). Conclusions: This study identifies the ASD “case phenotype,” intra-, and postoperative benchmarks associated with shorter LOS, providing targets for pathways designed to reduce LOS.

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Nutritional Insufficiency as a Predictor for Adverse Outcomes in Adult Spinal Deformity Surgery

Cited by 33 publications

References 44 publications

Association between hypoalbuminemia and complications after degenerative and deformity-correcting spinal surgeries: A systematic review and meta-analysis

Association between hypoalbuminemia and complications after degenerative and deformity-correcting spinal surgeries: A systematic review and meta-analysis

Hypoalbuminemia and Elevated CRP are Risk Factors for Deep Infections and Urinary Tract Infections After Lumbar Spine Surgery in a Large Retrospective Patient Population

Factors Associated With Short Length of Stay After Long Fusions for Adult Spinal Deformity: Initial Steps Toward Developing an Enhanced Recovery Pathway

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