Association between a prognostic nutritional index less than 50 and the risk of medical complications after adult spinal deformity surgery

Abstract

<jats:sec><jats:title>OBJECTIVE</jats:title><jats:p>Many complications are likely to occur in patients with malnutrition. The prognostic nutritional index (PNI) is often used when evaluating a patient’s nutritional condition. However, no studies have investigated the association between nutritional status and postoperative medical complications or prognosis by using the PNI in the field of spinal surgery. The purpose of this retrospective study was to investigate postoperative medical complications and prognoses of patients who had undergone adult spinal deformity (ASD) surgery, according to their preoperative nutritional status.</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>All patients aged ≥ 40 years who had undergone scheduled ASD surgery in the authors’ hospital between March 2010 and June 2017 were eligible for study inclusion and were divided into groups according to their PNI (&lt; 50, group L; ≥ 50, group H). Medical complications diagnosed within 30 days postoperatively were evaluated; however, surgical site infection and death were evaluated until 1 and 5 years after surgery, respectively.</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>Among the 285 eligible patients, groups L and H consisted of 118 and 167 patients, whose mean ages were 68.6 and 68.3 years, respectively. There was a significant difference in body mass index (22 vs 24 mg/kg<jats:sup>2</jats:sup>, respectively, p = 0.000), PNI (46 vs 55, p = 0.000), comorbidity of osteoporosis (50% vs 32%, p = 0.005) and autoimmune disease (13% vs 5%, p = 0.036), medical history of malignant disorder (17% vs 6%, p = 0.007), and medical complications (49% vs 23%, p = 0.000) between groups L and H. Multiple logistic regression analysis suggested that significant risk factors for postoperative medical complications were male sex (p = 0.000, OR 3.5, 95% CI 1.78–6.96), PNI &lt; 50 (p = 0.000, OR 2.9, 95% CI 1.69–4.93), and days to ambulation (p = 0.003, OR 1.1, 95% CI 1.02–1.09).</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p>Medical complication rates are significantly higher in patients with PNI &lt; 50, those with delayed ambulation, and male patients. In malnourished patients scheduled for ASD surgery, improvement of preoperative nutritional status and postoperative early ambulation are important to avoid medical complications.</jats:p></jats:sec>

Identifying risks factors in thoracolumbar anterior fusion surgery through predictive analytics in a nationally representative inpatient sample

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Preoperative prognostic nutritional index as a predictive factor for medical complication after cervical posterior decompression surgery: A multicenter study

“…Previous study reported almost same results. Oe et al 14,15 reported that a PNI < 50 was a risk factor for delirium and medical complications in patients undergoing ASD surgery. Delirium and medical complications result in longer hospital stays and fewer patients discharged to home.…”

Association between metabolic syndrome and venous thromboembolism after total joint arthroplasty: a meta-analysis of cohort studies

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