Study Design:
Retrospective study.
Objective:
To determine the rates of early postoperative mortality and morbidity in adults with
hypoalbuminemia undergoing elective posterior lumbar fusion (PLF).
Methods:
The American College of Surgeons National Surgical Quality Improvement Program (ACS
NSQIP) was examined from 2005 to 2012. Current Procedural Terminology (CPT) codes were
used to query the database for adults (≥18 years) who underwent PLF and/or
posterior/transforaminal lumbar interbody fusion (PLIF/TLIF). Patients were divided into
those with normal albumin concentration (≥3.5g/dL) and those with hypoalbuminemia
(<3.5 g/dL). Both univariate and multivariate analyses were performed.
Results:
A total of 2410 patients were included, of whom 2251 (93.4%) were normoalbuminemic and
159 (6.6%) were hypoalbuminemic. Patients with preoperative serum albumin levels <3.5
g/dL were older with a higher American Society of Anesthesiologists (ASA) score, and
more comorbidities, including anemia, diabetes, dependent functional status, and
preoperative history of chronic steroid therapy. Hypoalbuminemic patients had higher
rates of any 30-day perioperative complication (
P
< .001), unplanned
readmission (
P
= .019), and prolonged length of stay (LOS) >5 days
(
P
< .001). However, hypoalbuminemia was not significantly
associated with any specific perioperative complication. On multivariate analysis,
preoperative hypoalbuminemia was found to be an independent predictor of prolonged LOS
(OR 2.4, 95% CI 1.7-3.5;
P
< .001) and unplanned readmission (OR
2.7, 95% CI 1.1-6.3;
P
= .023).
Conclusion:
Hypoalbuminemia was found to be an important predictor of patient outcomes in this
population. This study suggests that clinicians should consider nutritional screening
and optimization as part of the preoperative risk assessment algorithm.
Level of Evidence:
III
Study Design:Retrospective cohort study.Objectives:The prevalence of obesity-related low back pain and degenerative disc disease is on the
rise. Past studies have demonstrated that obesity is associated with higher
perioperative complication rates, but there remains a gap in the literature regarding
additional risk factors that further predispose this already high-risk patient
population to poor surgical outcomes following elective posterior lumbar fusion (PLF).
The aim of the study is to identify independent risk factors for poor 30-day
perioperative outcomes in morbidly obese patients undergoing elective PLF.Methods:We identified 22 909 patients in the American College of Surgeons National Surgical
Quality Improvement Program database who underwent elective PLF. There were 1861
morbidly obese patients. Baseline patient demographics and medical comorbidities were
collected. Univariate analysis was performed to compare perioperative complication rates
between non-morbidly obese and morbidly obese patients. The 5 most common complications
in the morbidly obese group were then selected for multivariate regression analysis to
identify independent risk factors for poor 30-day outcomes.Results:Morbidly obese patients had a higher perioperative complication rate. The 5 most common
complications were prolonged hospitalization, blood transfusion, readmission, wound
complications, and reoperation. Independent risk factors for these complications were
age ≥65 years, super obesity (ie, BMI > 48.6), chronic steroid use, American Society
of Anesthesiology classification ≥3, poor functional status, long length of fusion ≥4
levels, and extended operative time (ie, operative time ≥318 minutes).Conclusions:Morbidly obese patients are at higher risk of perioperative complications following
elective PLF. Modifiable risk factors for the most common complications are obesity and
preoperative steroid use.
Study Design:Retrospective study.Objectives:To determine rates of medical and surgical postoperative complications in adults with
hypoalbuminemia undergoing anterior lumbar interbody fusion (ALIF).Methods:This was a retrospective analysis of prospectively collected data from the American
College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database
of patients (≥18 years old) undergoing ALIF procedures, identified by CPT (Current
Procedural Terminology) code from 2011 to 2014. Poor nutritional status was defined by a
preoperative serum albumin level <3.5 g/dL, and albumin levels above this were
considered normal. Multivariate logistic regression models were utilized to assess
preoperative risk factors including nutritional status as predictors of specific
postoperative complications. Significance was defined as P < .05 and
odds ratios (ORs) were calculated with a 95% confidence interval (CI). This model was
used to determine the strength of nutritional status as an adjusted predictor of adverse
postoperative events.Results:There were 3184 ALIF cases, including 1,275 (40%) of which had preoperative serum
albumin levels. 53 (4.15%) patients were classified as having poor nutrition status.
Poor preoperative nutritional status was shown to be a strong independent predictor of
length of stay ≥5 days (OR = 2.56, 95% CI 1.43-4.59, P = .002), urinary
tract infection (OR = 5.93, 95% CI 2.11-16.68, P = .001), and sepsis
(OR = 5.35, 95% CI 1.13-25.42, P = .035) compared to patients with
normal preoperative serum albumin levels.Conclusions:Our analysis shows that patients with poor nutritional status before ALIF are
independently at risk for sepsis as well as increased length of stay and urinary tract
infection.
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