Low preoperative serum prealbumin levels and the postoperative surgical site infection risk in elective spine surgery: a consecutive series

Abstract

<jats:sec><jats:title>OBJECTIVE</jats:title><jats:p>Nutritional deficiency negatively affects outcomes in many health conditions. In spine surgery, evidence linking preoperative nutritional deficiency to postoperative surgical site infection (SSI) has been limited to small retrospective studies. Authors of the current study analyzed a large consecutive cohort of patients who had undergone elective spine surgery to determine the relationship between a serum biomarker of nutritional status (preoperative prealbumin levels) and SSI.</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>The authors conducted a retrospective review of the electronic medical charts of patients who had undergone posterior spinal surgeries and whose preoperative prealbumin level was available. Additional data pertinent to the risk of SSI were also collected. Patients who developed a postoperative SSI were identified, and risk factors for postoperative SSI were analyzed. Nutritional deficiency was defined as a preoperative serum prealbumin level ≤ 20 mg/dl.</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>Among a consecutive series of 387 patients who met the study criteria for inclusion, the infection rate for those with preoperative prealbumin ≤ 20 mg/dl was 17.8% (13/73), versus 4.8% (15/314) for those with preoperative prealbumin &gt; 20 mg/dl. On univariate and multivariate analysis a low preoperative prealbumin level was a risk factor for postoperative SSI with a crude OR of 4.29 (p &lt; 0.01) and an adjusted OR of 3.28 (p = 0.02). In addition, several previously known risk factors for infection, including diabetes, spinal fusion, and number of operative levels, were significant for the development of an SSI.</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p>In this consecutive series, preoperative prealbumin levels, a serum biomarker of nutritional status, correlated with the risk of SSI in elective spine surgery. Prehabilitation before spine surgery, including strategies to improve nutritional status in patients with nutritional deficiencies, may increase value and improve spine care.</jats:p></jats:sec>

A Novel Prognostic Marker in Patients Undergoing Spinal Surgery: Prognostic Nutritional Index

“…25 On multivariate analysis, a low preoperative prealbumin level was a risk factor for postoperative surgical site infection. 25 In another retrospective database review, Puvanesarajah et al investigated the data of all patients aged 65 to 84 years who underwent elective one-to two-level posterior lumbar fusion for degenerative pathology. 26 Patients with diagnoses of poor nutritional status (kwashiorkor, nutritional marasmus, or other protein-calorie malnutrition that were coded either on the day of or within the 3-month period before the index procedure) were referred to as the "malnutrition cohort" and compared with a control cohort.…”

“…24 In a retrospective study, Salvetti and colleagues evaluated medical charts of patients who had undergone posterior spinal surgeries and revealed that the infection rate for those with preoperative prealbumin 20 mg/dL was 17.8% versus 4.8% for those with preoperative prealbumin > 20 mg/dL. 25 On multivariate analysis, a low preoperative prealbumin level was a risk factor for postoperative surgical site infection. 25 In another retrospective database review, Puvanesarajah et al investigated the data of all patients aged 65 to 84 years who underwent elective one-to two-level posterior lumbar fusion for degenerative pathology.…”

Nörocerrahi ve Eras (Enhanced Recovery After Surgery)

“…Nitekim, 25 mg/dL'den düşük pre albümin seviyesi 3 mg / dL'den düşük retinol bağlayıcı protein seviyesi ve 230 mg / dL'den düşük transferrin seviyesinin, abdominal aort anevrizması rezeksiyonu, torakotomi ile yapılan torasik cerrahi ve proktolojik/pankreas ameliyatları gibi majör elektif cerrahi geçiren hastalarda enfeksiyonlarla ilişkili olduğu belirtilmiştir 10 . Spinal cerrahide 20 mg/dL'den düşük pre albümin seviyesi nutrisyonel eksikliğin bir biyobelirteci olarak kabul edilmiş ve cerrahi saha enfeksiyonları ile ilişkilendirilmiştir 11 . Bu nedenle, preoperatif serum albümin düzeyi <3,5 g/dL olan, vücut kitle indeksi (VKİ) <18,5 veya >25 olan yüksek riskli hastalarda ameliyat öncesi beslenme konsültasyonu ile hastaların değerlendirilmesi ve beslenme eğitimi önerilmektedir.…”

Prehabilitation and Optimization of Modifiable Patient Risk Factors: The Importance of Effective Preoperative Evaluation to Improve Surgical Outcomes

“…Although there is no agreed‐upon definition, patients are considered frail if they have three of the following criteria: significant recent unintended weight loss with a low body mass index (BMI), a decreased energy level, a slow walking speed, decreased physical activity, or a weak grip strength . These patients have very high postoperative complication and mortality rates . Many frail patients have sarcopenia (ie, reduced muscle mass).…”