Introduction: Previous studies have described preoperative nutritional status to be an important predictor of postoperative recovery as well as outcomes. Serum albumin concentration is an established clinical marker of overall nutritional status and systemic disease; however, its correlation to outcomes following posterior cervical fusion (PCF) has not been previously studied.
Methods: Adult patients (>18 years) who underwent PCF (CPT 22600) were identified in the NSQIP database and divided into two groups: those with normal albumin concentration (=3.5g/dL) and those with hypoalbuminemia (<3.5g/dL). Independent patient demographics and comorbidity variables were assessed. Univariate analysis was performed to assess whether nutritional status was a potential risk factor for complications and outcomes. Only variables with p<0.2 in the univariate analysis were evaluated for inclusion in the final step-wise multivariate logistic regression model used to determine the strength of preoperative hypoalbuminemia as an adjusted predictor of major postoperative complications and outcomes. Statistical significance was maintained at p<0.05.
Results: A total of 180 patients were identified, 29 (16.1%) of which had preoperative albumin measurements. Patients with albumin measurements were more likely to be American Society of Anesthesiologists (ASA) Class =3, have diabetes mellitus and dependent functional status (all p<0.0001). Hypoalbuminemic patients were more likely to be on renal dialysis (p=0.02), have neuromuscular injury (p=0.002) and bleeding disorder (p=0.05). In terms of operative variables, there were no differences between the two groups in operative time (p=0.2), however, those with hypoalbuminemia had greater mean total relative value unit (RVU) associated with surgery (p=0.001). In regards to complications, hypoalbuminemic patients had higher rates of any complication (p=0.0002) including death (p=0.001), pulmonary (p=0.05) and cardiac (p=0.02) complication and were more likely to require extended LOS >5 days (p<0.0001). With multivariate regression analysis, preoperative hypoalbuminamia was found to be an independent predictor of any postoperative complication (OR 4.76, 95% CI 1.16-19.46, p=0.03) and LOS >5 days (OR 5.84, 95% CI 1.89-18.03, p<0.002).
Conclusions: Hypoalbuminemia (<3.5g/dL) was found to be a predictor of any complication and increased LOS (>5 days) in patients undergoing PCF. This study suggests that clinicians should consider nutritional screening and optimization as part of the preoperative risk assessment algorithm.
Patient Care: Patient care should be improved with widespread knowledge and understanding of the importance of preoperative nutritional status prior to undergoing cervical spine surgery.
Learning Objectives: By the conclusion of this session, participants should be able to understand the effect of preoperative nutritional status, as measured by serum albumin concentration, on overall complications, prolonged length of stay and 30-day unplanned readmission in adults undergoing elective PCF.