TY - JOUR
T1 - Low preoperative serum prealbumin levels and the postoperative surgical site infection risk in elective spine surgery
T2 - A consecutive series
AU - Salvetti, David J.
AU - Tempel, Zachary J.
AU - Goldschmidt, Ezequiel
AU - Colwell, Nicole A.
AU - Angriman, Federico
AU - Panczykowski, David M.
AU - Agarwal, Nitin
AU - Kanter, Adam S.
AU - Okonkwo, David O.
N1 - Publisher Copyright:
© AANS 2018.
PY - 2018/11
Y1 - 2018/11
N2 - OBJECTIVE 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. METHODS 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. RESULTS 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 > 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 < 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. CONCLUSIONS 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.
AB - OBJECTIVE 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. METHODS 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. RESULTS 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 > 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 < 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. CONCLUSIONS 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.
KW - Infection risk
KW - Nutritional deficiency
KW - Prealbumin
KW - Spine surgery
KW - Surgical site infections
UR - http://www.scopus.com/inward/record.url?scp=85055889515&partnerID=8YFLogxK
U2 - 10.3171/2018.3.SPINE171183
DO - 10.3171/2018.3.SPINE171183
M3 - Article
C2 - 30052149
AN - SCOPUS:85055889515
SN - 1547-5654
VL - 29
SP - 549
EP - 552
JO - Journal of Neurosurgery: Spine
JF - Journal of Neurosurgery: Spine
IS - 5
ER -