TY - JOUR
T1 - Nutritional Insufficiency as a Predictor for Adverse Outcomes in Adult Spinal Deformity Surgery
AU - Phan, Kevin
AU - Kim, Jun S.
AU - Xu, Joshua
AU - Di Capua, John
AU - Lee, Nathan J.
AU - Kothari, Parth
AU - Vig, Khushdeep S.
AU - Dowdell, James
AU - Cho, Samuel K.
N1 - Publisher Copyright:
© 2017, © The Author(s) 2017.
PY - 2018/4/1
Y1 - 2018/4/1
N2 - Study Design: Retrospective analysis of prospectively collected data. Objective: The effect of malnutrition on outcomes after general surgery has been well reported in the literature. However, there is a paucity of data on the effect of malnutrition on postoperative complications during adult deformity surgery. The study attempts to explore and quantify the association between hypoalbuminemia and postoperative complications. Methods: A retrospective cohort analysis was performed on the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database from 2010 to 2014. Patients (≥18 years of age) from the NSQIP database undergoing adult deformity surgery were separated into cohorts based serum albumin (<3.5 or >3.5 g/dL). Chi-square and multivariate logistic regression models were used to identify independent risk factors. Results: A total of 2236 patients met the inclusion criteria for the study, of which 2044 (91.4%) patients were nutritionally sufficient while 192 (8.6%) patients were nutritionally insufficient. Multivariate logistic regressions revealed nutritional insufficiency as a risk factors for mortality (odds ratio [OR] = 15.67, 95% confidence interval [CI] = 6.01-40.84, P <.0001), length of stay ≥5 days (OR = 2.22, 95% CI = 1.61-3.06, P <.0001), any complications (OR = 1.82, 95% CI = 1.31-2.51, P <.0001), pulmonary complications (OR = 2.29, 95% CI = 1.29-4.06, P =.005), renal complications (OR = 2.71, 95% CI = 1.05-7.00, P =.039), and intra-/postoperative red blood cell transfusion (OR = 1.52, 95% CI = 1.08-2.12, P =.015). Conclusions: This study demonstrates that preoperative hypoalbuminemia is a significant and independent risk factor for postoperative complications, 30-day mortality, and increased length of hospital in patients undergoing adult deformity surgery surgery. Nutritional status is a modifiable risk factor that can potentially improve surgical outcomes after adult deformity surgery.
AB - Study Design: Retrospective analysis of prospectively collected data. Objective: The effect of malnutrition on outcomes after general surgery has been well reported in the literature. However, there is a paucity of data on the effect of malnutrition on postoperative complications during adult deformity surgery. The study attempts to explore and quantify the association between hypoalbuminemia and postoperative complications. Methods: A retrospective cohort analysis was performed on the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database from 2010 to 2014. Patients (≥18 years of age) from the NSQIP database undergoing adult deformity surgery were separated into cohorts based serum albumin (<3.5 or >3.5 g/dL). Chi-square and multivariate logistic regression models were used to identify independent risk factors. Results: A total of 2236 patients met the inclusion criteria for the study, of which 2044 (91.4%) patients were nutritionally sufficient while 192 (8.6%) patients were nutritionally insufficient. Multivariate logistic regressions revealed nutritional insufficiency as a risk factors for mortality (odds ratio [OR] = 15.67, 95% confidence interval [CI] = 6.01-40.84, P <.0001), length of stay ≥5 days (OR = 2.22, 95% CI = 1.61-3.06, P <.0001), any complications (OR = 1.82, 95% CI = 1.31-2.51, P <.0001), pulmonary complications (OR = 2.29, 95% CI = 1.29-4.06, P =.005), renal complications (OR = 2.71, 95% CI = 1.05-7.00, P =.039), and intra-/postoperative red blood cell transfusion (OR = 1.52, 95% CI = 1.08-2.12, P =.015). Conclusions: This study demonstrates that preoperative hypoalbuminemia is a significant and independent risk factor for postoperative complications, 30-day mortality, and increased length of hospital in patients undergoing adult deformity surgery surgery. Nutritional status is a modifiable risk factor that can potentially improve surgical outcomes after adult deformity surgery.
KW - ACS
KW - NSQIP
KW - adult spinal deformity
KW - complications
KW - fusion
KW - hypoalbuminemia
KW - insufficiency
KW - malnutrition
KW - mortality
KW - nutrient
UR - http://www.scopus.com/inward/record.url?scp=85044829602&partnerID=8YFLogxK
U2 - 10.1177/2192568217708777
DO - 10.1177/2192568217708777
M3 - Article
AN - SCOPUS:85044829602
SN - 2192-5682
VL - 8
SP - 164
EP - 171
JO - Global Spine Journal
JF - Global Spine Journal
IS - 2
ER -