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 spine fusion surgery remain unknown. In this study, we assess the predictive value of pre-operative nutritional status (serum albumin level) on post-operative complication rates.
Methods: The medical records of 136 patients undergoing 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 (malnourished). Patient demographics, comorbidities, and post-operative complication rates were collected. Patients were also stratified into two groups based on their etiology, namely elective degenerative/deformity versus non-elective cases. The association between pre-operative serum albumin level and post-operative complication was assessed via multivariate logistic regression analysis.
Results: Overall, 40 (29.4%) patients experience at least one postoperative complication. Patients undergoing elective surgery had a difference in postoperative complication rates based on pre-operative albumin levels (malnourished: 35.7% vs. nourished: 11.7%, p=0.03), whereas those undergoing non-elective surgery had similar complication rates (malnourished: 46.5% vs. nourished: 42.1%, p=0.75), Table 1. For patients undergoing elective spinal surgery, logistic regression with and without propensity score adjustment for risk factors, demonstrated that preoperative serum albumin level was a significant predictor of postoperative complications (OR: 4.21, CI: 95% (1.09, 16.19), p=0.04) and (OR: 4.54, CI: 95% (1.17, 19.32), p=0.04), respectively, Table 2.
Conclusions: Pre-operative hypoalbuminemia is an independent risk factor for postoperative complications following elective spine surgery for degenerative and deformity causes, and should be used more frequently as a prognostic tool to detect malnutrition and risk of adverse surgical outcomes.
Patient Care: Hypoalbuminemia should be used more frequently as a prognostic tool to detect malnutrition and risk of adverse surgical outcomes.
Learning Objectives: Pre-operative hypoalbuminemia is an independent risk factor for postoperative complications following elective spine surgery