Perioperative Nutrition and Postoperative Complications in Patients Undergoing Spinal Surgery

Klein, Jeffrey D.; Hey, Lloyd A.; Yu, Chun Sing; Klein, Barbi B.; Coufal, Frank; Young, Edmond P.; Marshall, Lawrence F.; Garfin, Steven R.

doi:10.1097/00007632-199611150-00018

Cited by 228 publications

(138 citation statements)

References 25 publications

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“…This may be controlled by the use of a separate drain in this layer to prevent the development of dead space. Preoperative weight loss can also modify a patient's obesity but weight loss should be done in a balanced matter to prevent malnutrition which can increase the risk for SSI [13,20,21].…”

Section: Discussionmentioning

confidence: 99%

“…As a result, SSI following spinal surgery is creating an increasing cost burden on our society making it important that we understand the risk factors for SSI so that infection risk can be minimized. Within the literature, different patient characteristics (age [12,13], obesity [9,[14][15][16][17][18], diabetes [14,19], presence of more than three co-morbid diseases [9], urinary incontinence [9], tobacco use [14], poor nutritional status [13,20,21], complete neurological deficit [22] and non-steroidal anti-inflammatory drugs use [23]) and operative characteristics (revision surgery [14,15], posterior surgical approach [9], tumor resection [9], increased estimated blood loss [14,20], prolonged surgical time [14] and multilevel surgery fusions extending to the sacrum [24]) have been identified as risk factors for SSI.…”

Section: Introductionmentioning

confidence: 99%

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Incidence of surgical site infection following adult spinal deformity surgery: an analysis of patient risk

2010

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Surgical site infection (SSI) following spinal surgery is a frequent complication and results in higher morbidity, mortality and healthcare costs. Patients undergoing surgery for spinal deformity (scoliosis/kyphosis) have longer surgeries, involving more spinal levels and larger blood losses than typical spinal procedures. Previous research has identified risk factors for SSI in spinal surgery, but few studies have looked at adult deformity surgeries. We retrospectively performed a large case cohort analysis of all adult patients who underwent surgery for kyphosis or scoliosis, between June 1996 and December 2005, by our adult spine division in an academic institution to asses the incidence and identify risk factors for SSI. We reviewed the electronic patient records of 830 adult patients. SSI was classified as deep or superficial to the fascia. 46 (5.5%) patients were found to have a SSI with 29 patients (3.5%) having deep infections. Obesity was found to be an independent risk factor for all SSI and superficial SSI (P = 0.014 and P = 0.013). As well, a history of prior SSI was also found to be a risk factor for SSI (P = 0.041). Patient obesity and history of prior SSI lead to increased risk of infection. Since obesity was related to an increased risk of both superficial and deep SSI, counseling and treatment for obesity should be considered before elective deformity surgery.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Incidence of surgical site infection following adult spinal deformity surgery: an analysis of patient risk

2010

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“…The incidence of malnutrition is high in hospitalized patients, with a range of 30-50% according to the population group and time of nutritional assessment (Jensen et al, 1982;Mandelbaum et al, 1988;Celaya, 1992;Klein et al, 1996;Bruun et al, 1999;Correia et al, 2003). In various clinical and surgical populations, these nutritional deficiencies have been related with increased morbidity and mortality rates (Cannon et al, 1944;Mandelbaum et al, 1988).…”

Section: Introductionmentioning

confidence: 99%

“…The documented risk factors for nutritional depletion in patients undergoing major spinal surgery are patient age over 50 y (Lenke et al, 1995;Klein et al, 1996), diagnosis of cerebral palsy (Jevsevar & Karlin, 1993;Hu et al, 1998), circumferential spinal surgery (Lenke et al, 1995;Klein et al, 1996;Hu et al, 1998), and fusion levels equal to or greater than 10 (Jevsevar & Karlin, 1993).…”

Section: Introductionmentioning

confidence: 99%

Analysis of nutritional parameters in idiopathic scoliosis patients after major spinal surgery

et al. 2005

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Objective: The aim of the study is to investigate the evolution of nutritional parameters after major spinal surgery in patients with idiopathic scoliosis. Methods: This retrospective study included 31 patients with a mean age of 18 y, diagnosed with idiopathic scoliosis. The following variables were analyzed: demographic, surgical (type, number of fused segments, duration, and blood loss), nutritional assessment (proteins, albumin, prealbumin, transferrin, lymphocytes, and body mass index), and duration of hospitalization at different time points. Statistical analyses were performed with the SPSS 6.1 software. Results: Before surgery, nutritional status was normal in all patients. At 24-48 h after surgery, statistically significant decrease with respect to preoperative values was recorded for all the parameters studied: proteins (Po0.001), albumin (Po0.001), prealbumin (Po0.01), transferrin (Po0.001), and lymphocytes (Po0.001). Conclusion: Our results showed a significant postoperative decrease in the nutritional parameters analyzed in a previously wellnourished population considered to be at low risk for nutritional depletion.

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“…Surprisingly, the effect of preoperative nutritional status on the outcome of patients has not been reported in the literature. Indeed, the relationship between poor nutritional status and subsequent postoperative morbidity and mortality is well recognised in the surgical literature 13,14,22 .This study aims to determine the prevalence of undernutrition and its influence on outcome and hospital stay in hydrocephalus patients undergoing shunt surgery in India. In addition, we also sought to determine the nutrition parameter † Work performed…”

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confidence: 99%

The impact of nutritional status on the outcome of Indian patients undergoing neurosurgical shunt surgery

et al. 2007

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Undernutrition is common in surgical patients, is frequently unrecognised and is strongly associated with adverse outcomes such as high rates of complications and mortality, worsening functional status and prolonged hospitalisation. Owing to the associated infection and symptoms such as repeated vomiting, a high prevalence of undernutrition is expected in hydrocephalus patients, which may contribute to their poor surgical outcomes. The aim of this study was to evaluate the influence of preoperative nutritional status on the outcome of Indian patients with hydrocephalus undergoing neurosurgical shunt surgery. One hundred and twenty-four consecutive patients undergoing scheduled hydrocephalus shunt surgery were studied prospectively. All patients underwent nutritional screening according to different parameters prior to surgery. The patients were classified into normally nourished and undernourished groups. The undernourished group was further subdivided into moderately and severely undernourished. The surgical outcome was compared between these groups. A high prevalence (53 %) of undernutrition was observed in these patients. Postoperative complications such as shunt infection (P¼0·0023), shunt revision (P¼ 0·0074) and mortality (P¼ 0·0003) were significantly more common in undernourished patients compared with normally nourished patients. Serum albumin emerged as the most significant independent predictor of postoperative mortality. The present study demonstrated a high prevalence of undernutrition in hydrocephalus patients in India and its adverse influence on the outcome of shunt surgery. Early preoperative nutritional status screening and its optimisation may decrease the morbidity and mortality of shunt surgery for hydrocephalus. Nutritional status: Hydrocephalus: Neurosurgical shunt surgeryThe influence of nutritional status on the course of an illness was already known to Hippocrates when he stated that well-fed patients would recover more quickly 1 . Since then, numerous studies have widely acknowledged the deleterious effects of impaired nutritional status on clinical outcome 2 -4 and hospital costs 5 . Undernutrition, however continues to be a significant problem in surgical patients, with up to 40 % of patients being undernourished on admission to hospital, and about 78 % of the undernourished patients who stay longer in hospital losing further weight 6 -8 .This deterioration of nutritional status in the patient undergoing surgery may result in reduced systemic immunity, an exaggerated stress response, organ system dysfunction, poor wound healing and delayed functional recovery 7,9 -14 . Therefore, careful preoperative nutritional assessment followed by the initiation of appropriate nutritional therapies has been proposed to improve outcomes 12 . Hydrocephalus is a clinical condition marked by the excessive accumulation of cerebrospinal fluid within the cerebral ventricles. It is more frequent in children and results from congenital or acquired disease processes including developmental anomalies, neop...

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Perioperative Nutrition and Postoperative Complications in Patients Undergoing Spinal Surgery

Cited by 228 publications

References 25 publications

Incidence of surgical site infection following adult spinal deformity surgery: an analysis of patient risk

Incidence of surgical site infection following adult spinal deformity surgery: an analysis of patient risk

Analysis of nutritional parameters in idiopathic scoliosis patients after major spinal surgery

The impact of nutritional status on the outcome of Indian patients undergoing neurosurgical shunt surgery

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