Perioperative Hypoalbuminemia is a Risk Factor for Wound Complications Following Posterior Lumbar Interbody Fusion

Abstract

Background: Although serum albumin levels are increasingly used as an indicator of nutritional status in the clinic, the relationship between perioperative hypoalbuminemia and wound complications after posterior lumbar interbody fusion in the treatment of lumbar degenerative disease remains ambiguous. The aim of this study was to evaluate perioperative serum albumin in relation to postoperative wound complications after posterior lumbar interbody fusion in the treatment of single-segment lumbar degenerative disease. Methods: We reviewed patients who underwent single-segment posterior lumbar interbody fusion surgery from December 2014 to April 2017 in the Department of Orthopedics at the First Affiliated Hospital of Chongqing Medical University. Perioperative (preoperative and early postoperative) serum albumin levels were assessed in all patients and were used to quantify nutritional status. We divided the patients into a surgical wound dehiscence ( SWD ) group and a normal wound healing group, and into an surgical site infection(SSI)group and a non-SSI group. To evaluate the relationship between perioperative serum albumin level and postoperative wound complications, we conducted univariate and multiple logistic regression analyses. Results: A total of 554 patients were enrolled in the study.The univariate and multiple logistic regression analysis of these differences showed that preoperative serum albumin <3.5 g/dl and postoperative serum albumin:<3.0 g/dl were significantly related to SWD (P<0.05). There were also significant differences between the surgical site infection (SSI) groups in terms of preoperative serum albumin <3.5 g/dl(P=0.001), postoperative serum albumin <3.5 g/dl (P<0.023) and <3.0 g/dl(P<0.001).Additionally, the increased hospitalization costs and length of hospitalization were statistically significant for patients with perioperative hypoproteinemia. Conclusions: For patients who underwent single-segment posterior lumbar interbody fusion surgery, we need to pay more attention to steroid use,perioperative hypoalbuminemia, which are more likely to be associated with increased wound complications, hospitalization costs and length of hospitalization after surgery. Adequate assessment and management of these risk factors will help reduce wound complications and hospital stays for surgical patients and will save medical costs. Keywords: hypoalbuminemia,malnutrition,risk factors,single-segment lumbar fusion,postoperative incision complications,retrospective studies.

Albumin and infection following a procedure: a Mendelian Randomization study

“…Ogimi et al suggested that albumin < 3g/dL was associated with occurrence of seasonal human coronavirus lower respiratory tract infection [37]. Zhongyuan et al suggested that preoperative serum albumin < 3.5g/dL was signi cantly correlated with surgical site infection (SSI) and postoperative serum albumin < 3.0 g/dL was signi cantly correlated with surgical wound dehiscence in lumbar spine surgeries [12]. Danan et al suggested that preoperative albumin was a signi cant predictor of wound infection in surgeries for head and neck cancer [38].…”

“…Serum albumin concentration was proposed to be an important changeable factor increasing the risk of the IFP, and a perioperative albumin supplementation was recommended [9][10][11][12][13]. However, these hypotheses remain controversial and lack proofs from randomized controlled trials (RCTs) [14][15][16][17].…”

The impact of stratified hypoalbuminemia and dialysis on morbidity/mortality after posterior spinal fusion surgery: An ACS-NSQIP study

“…Other studies have demonstrated albumin's role in the healing process and associated hypoalbuminemia with woundrelated complications. [6,8] He et al showed a significant…”

“…correlation between lower albumin levels and delayed wound healing in 554 patients undergoing single-level posterior lumbar fusion surgery. [6] Others found low albumin levels contributed to higher risks of major complications in spine surgery. [9] No association between hypoalbuminemia and reoperations/unplanned readmission Interestingly, we found no significant association between hypoalbuminemia and reoperations or unplanned readmissions.…”