Perioperative hypoalbuminemia is a risk factor for wound complications following posterior lumbar interbody fusion

Abstract

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) and 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.

Nutrition and Vitamin Deficiencies Are Common in Orthopaedic Trauma Patients

“…Our study reinforces prior literature on the prevalence and impact of hypoalbuminemia in an orthopaedic trauma population [ 8 , 26 ] and confirms that malnutrition is a risk factor for wound complications [ 27 , 28 ]. Our study also confirms prior research demonstrating significant vitamin D deficiency in a diverse trauma population [ 12 ].…”

The "Ant-farm"-like Appearance of Restricted Lower Limb Vasculitis on Fluorodeoxyglucose-positron Emission Tomography

“…Although the gold standard for diagnosing muscle vasculitis is a biopsy ( 2 ), a muscle biopsy can be false negative by 33.3% for muscular involvement of vasculitis ( 13 ). Furthermore, accompanying hypoalbuminemia due to a chronic inflammatory status often limits the indication of a muscle biopsy ( 14 ). Therefore, we would like to emphasize the usefulness of FDG-PET for detecting restricted lower limb vasculitis non-invasively in patients with lower limb pain and a fever of unknown origin.…”

Preoperative hypoalbuminemia and dialysis increase morbidity/mortality after spine surgery for primary pyogenic spinal infections (ACS-NSQIP Study)

“…Prior studies have demonstrated albumin’s role in the healing process and how hypoalbuminemia highly correlates with greater risks for wound-related complications [ Table 5 ]. [ 1 , 2 , 6 , 11 , 12 ] Specifically, Schoenfeld et al . analyzed 5887 patients who underwent spinal fusion surgery through a NSIQP database and found that patients’ age, ASA more than 2, high BMI, and poor nutritional status increased the risk of complications and mortality.…”

“…[ 9 ] This incidence will likely increase given the rising prevalence of spine operations performed in an aging population with increased comorbidities including diabetes, renal failure, and intravenous drug use. [ 6 , 7 ] Here, we explored the correlation between hypoalbuminemia and/or dialysis with the incidence of perioperative (i.e., defined as <30 postoperative days) morbidity and mortality in patients undergoing primary surgery for PSIs.…”