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. 2018 Apr;8(2):164-171.
doi: 10.1177/2192568217708777. Epub 2017 Jun 30.

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

Kevin Phan  1   2 , Jun S Kim  3 , Joshua Xu  2 , John Di Capua  3 , Nathan J Lee  3 , Parth Kothari  3 , Khushdeep S Vig  3 , James Dowdell  3 , Samuel K Cho  3
Affiliations

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

Kevin Phan et al. Global Spine J. 2018 Apr.

Abstract

Study design: Retrospective analysis of prospectively collected data.

Objective: The effect of malnutrition on outcomes after general surgery has been well reported in the literature. However, there is a paucity of data on the effect of malnutrition on postoperative complications during adult deformity surgery. The study attempts to explore and quantify the association between hypoalbuminemia and postoperative complications.

Methods: A retrospective cohort analysis was performed on the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database from 2010 to 2014. Patients (≥18 years of age) from the NSQIP database undergoing adult deformity surgery were separated into cohorts based serum albumin (<3.5 or >3.5 g/dL). Chi-square and multivariate logistic regression models were used to identify independent risk factors.

Results: A total of 2236 patients met the inclusion criteria for the study, of which 2044 (91.4%) patients were nutritionally sufficient while 192 (8.6%) patients were nutritionally insufficient. Multivariate logistic regressions revealed nutritional insufficiency as a risk factors for mortality (odds ratio [OR] = 15.67, 95% confidence interval [CI] = 6.01-40.84, P < .0001), length of stay ≥5 days (OR = 2.22, 95% CI = 1.61-3.06, P < .0001), any complications (OR = 1.82, 95% CI = 1.31-2.51, P < .0001), pulmonary complications (OR = 2.29, 95% CI = 1.29-4.06, P = .005), renal complications (OR = 2.71, 95% CI = 1.05-7.00, P = .039), and intra-/postoperative red blood cell transfusion (OR = 1.52, 95% CI = 1.08-2.12, P = .015).

Conclusions: This study demonstrates that preoperative hypoalbuminemia is a significant and independent risk factor for postoperative complications, 30-day mortality, and increased length of hospital in patients undergoing adult deformity surgery surgery. Nutritional status is a modifiable risk factor that can potentially improve surgical outcomes after adult deformity surgery.

Keywords: ACS; NSQIP; adult spinal deformity; complications; fusion; hypoalbuminemia; insufficiency; malnutrition; mortality; nutrient.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

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