Janesh Karnati, B.A.: No financial relationships to disclose
Introduction: Hypoalbuminemia, defined as serum albumin < 3.5 g/dL, is commonly used as an indicator of malnutrition and has been identified as a significant risk factor for postoperative complications, such as surgical site infection (SSI) and wound dehiscence (WD). Preoperative nutritional assessment practices vary, and there is limited research examining the impact of malnutrition on complication rates following posterior lumbar spine surgery in large patient cohorts.
Methods: The TriNetX Research Network was queried to identify adult patients who underwent posterior spinal instrumentation surgery spanning 3-6 or 7-12 levels, with preoperative diagnoses of lumbar spinal stenosis or spondylolisthesis, and a preoperative albumin level measured within 30 days before surgery. The study cohort was divided into two groups based on serum albumin levels: those below 3.5 g/dL and those at or above 3.5 g/dL. Propensity score matching was applied to adjust for age, gender, race, and comorbidities. Postoperative occurrences of wound dehiscence, surgical site infection (SSI), and the need for a return to the operating room were identified using corresponding procedural and diagnostic codes within 90 days of the index surgery.
Results: A total of 10,340 patients met the initial inclusion criteria (mean age at surgery: 65.1 years [SD, 11.5]; 4,391 [42.5%] male), with 1,720 (16.6%) having an albumin level below 3.5 g/dL within 30 days of surgery. Following propensity score matching, each cohort included 1,715 patients, with no significant differences in baseline demographics or comorbidities between the groups. After matching, malnourished patients continued to have significantly higher odds of developing SSI or WD and requiring reoperation within 90 days (OR = 1.677 and OR = 1.755, respectively).
Conclusion : This large-scale retrospective study, utilizing propensity score matching, indicates that malnutrition, defined by hypoalbuminemia ( < 3.5 g/dL), is prevalent (16.6%) among adults undergoing multi-level posterior lumbar spinal instrumentation. Malnourished patients exhibited approximately 70% higher odds of developing postoperative complications—including surgical site infection (SSI), wound dehiscence, and the need for reoperation—compared to adequately nourished patients. These findings suggest that preoperative nutritional status should be considered as part of the risk assessment process for patients undergoing spine surgery.
.jpg)
