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
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