Introduction: The substantial prevalence of malnutrition in the hospitalized patient population has only been recently recognized. Preoperative hypoalbuminemia (serum albumin =3.5 g/dL) has been shown to be associated with increased morbidity and mortality rates in hospitalized patients. The prognostic implications and significance of hypoalbuminemia after multilevel spine surgery remains unknown. In this study, we asses the predictive value of pre-operative nutritional status(serum albumin level) on post-operative complication rates.
Methods: The medical records of 25 patients undergoing elective long-segment thoracolumbar spine fusion at Duke University hospital were reviewed. Pre-operative Serum albumin level was assessed on all patients and used to quantify nutritional status. Albumin less than 3.5 g/dL was recognized as hypoalbuminemia. Patient demographics, comobidites, post-operative complication rates (renal, cardiac, neurological, DVT/PE, wound infection) and length of hospital stay were assessed. The association between pre-operative serum albumin level and post-operative infection was assessed via multivariate logistic regression analysis.
Results: Both patient cohorts were matched at baseline. Overall, 8(32%) patients experience atleast 1 postoperative complication [malnourished cohort: 6(60%) patients vs. nourished cohort: 2(13.33%) patients, p=0.02]. Overall, the average BMI was 27.42±5.82(malnourished: 28.13±19.34 vs. nourished: 27.09±4.55, p=0.76). Independent of patient age, BMI, gender, comorbidity(smoking, COPD, CAD, AFib, CHF) and baseline serum creatinine level, preoperative serum albumin level was a significant predictor of postoperative complications(p=0.02).
Conclusions: Pre-operative hypoalbuminemia is an independent risk factor for postoperative complications following spine surgery and should be used more frequently as a prognostic tool to detect malnutrition and risk of adverse surgical outcomes.
Patient Care: This research shows a prognostic tool to detect risk of adverse surgical outcomes.
Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the association between baseline serum albumin and the post-operative surgical complications