Is preoperative S-albumin associated to postoperative complications and readmission in patients with adult spinal deformity: a prospective analysis of 128 patients using the Spine AdVerse Event Severity (SAVES) system

Preoperative Serum Albumin and TLC as Predictors of Postoperative Complications in Spine Surgery

STUDY DESIGN

Narrative review.

PURPOSE

To investigate the state of literature regarding serum albumin and total lymphocyte count and their associations with postoperative complications after spine surgery.

METHODS

Comprehensive search of the PubMed database was performed to find relevant articles addressing preoperative serum albumin, total lymphocyte count, or their respective composite scores and their associations with postoperative complications after spine surgery.

SUMMARY OF BACKGROUND DATA

Serum albumin level is frequently cited as a marker of patient nutritional status. Total lymphocyte count has more recently gained attention in the literature for similar reasons. Identification of modifiable preoperative patient risk factors for postoperative complications such as malnutrition may help minimize the incidence of postoperative complications.

RESULTS

Review of the literature revealed 10 studies that discussed the association between preoperative hypoalbuminemia and postoperative complications. Five studies examined the relationship between either prognostic nutritional index (PNI), controlling nutritional status (CONUT), or both and postoperative complications after spine surgery. Preoperative hypoalbuminemia, low PNI, and high CONUT scores were associated with increased risk of postoperative complications after spine surgery.

CONCLUSIONS

Preoperative malnourishment is a modifiable patient factor that is associated with an increased risk of postoperative complications after spine surgery.

Preoperative nutritional optimization for adult spinal deformity: Review

PURPOSE

The main objective of this review article is to examine the role that nutrition has on adult spinal deformity. The information presented in this review aims to provide spine surgeons with a broad overview of screening, assessment, and interventional strategies that may be used for presurgical nutritional optimization.

METHODS

A comprehensive literature review utilizing three biomedical databases was performed to generate articles of interest. Published articles related to nutrition, adult spinal deformity, spine surgery and orthopaedics were reviewed for the composition of this article. Nutrition may play a role in optimizing postoperative outcomes following adult spinal deformity surgeries, such as limiting delirium, length of stay, blood transfusion, and other medical complications. The use of screening tools, such as the PNI and CONUT score can assess preoperative nutritional status and may provide some utility in evaluating nutrition status in patients undergoing deformity surgery. Balancing both macronutrients and micronutrients, notably, carbohydrates, protein, albumin, and vitamin D can play a role in preoperative optimization.

CONCLUSION

Adult spinal deformity patients are at an increased risk for malnutrition. These patients should be assessed for nutrition status to prime them for surgery, minimize complications, and maximize their outcomes. However, further studies are needed to determine how nutrition ultimately affects adult spinal deformity patients in the postoperative period and to establish specific nutritional recommendations for this unique population.

Preoperative Optimization for Adult Spinal Deformity Surgery: A Systematic Review

STUDY DESIGN

Systematic review.

OBJECTIVE

The purpose of this review is to identify modifiable risk factors in patients undergoing adult spinal deformity surgery and compile literature recommendations for the preoperative optimization of these risk factors.

SUMMARY OF BACKGROUND DATA

Optimization of modifiable risk factors not only benefits the patient but also lessens resource and cost burdens on the health care system, allowing for better quality and value-based care. There is limited but applicable literature discussing preoperative optimization in adult spinal deformity surgery patients specifically.

METHODS

We searched PubMed for studies that looked at one of the variables of interest (eg, osteoporosis, prehabilitation and functional status, multidisciplinary preoperative screening, infection, obesity, nutrition, smoking, diabetes, blood loss, chronic opioid use, and psychosocial factors) in adult patients with spinal deformity according to Preferred Reporting Items for Systematic Reviews and Meta-Analyse guidelines.

RESULTS

Seventy studies were included in the final review and synthesis of information. Guidelines and recommendations from these studies were compared and compiled into evidence-based action items for preoperative optimization of modifiable risk factors before adult spinal deformity surgery.

CONCLUSIONS

While the approach of preoperative optimization of modifiable risk factors may incur additional planning efforts and patient care time, it has the potential to significantly reduce perioperative complications and reduce morbidity and mortality during surgery, thus allowing for improved outcomes, increased quality of life, and satisfaction from this patient population.

LEVEL OF EVIDENCE

3.

Association between hypoalbuminemia and complications after degenerative and deformity-correcting spinal surgeries: A systematic review and meta-analysis

Objective

The current review was designed to explore if hypoalbuminemia is associated with increased complications in patients undergoing spinal degenerative and deformities surgeries.

Methods

The search for eligible studies was conducted on the databases of PubMed, Embase, Web of Science, and CENTRAL up to 20th June 2022. Complication rates were pooled to obtain odds ratio (OR) and 95% confidence intervals.

Results

Thirteen studies were included. We found that hypoalbuminemia was significantly associated with increased risk of all complications (OR: 2.72 95% CI: 2.04, 3.63 I ²= 58% p < 0.00001), mortality (OR: 7.73 95% CI: 3.81, 15.72 I ²= 0% p < 0.00001), revision surgery (OR: 3.15 95% CI: 1.53, 6.48 I ²= 87% p = 0.002), readmissions (OR: 1.96 95% CI: 1.29, 2.98 I ²= 23% p = 0.02), surgical site infections (OR: 2.97 95% CI: 1.90, 4.63 I ²= 38% p < 0.00001), wound complications (OR: 2.31 95% CI: 1.17, 4.56 I ²= 48% p = 0.02), pulmonary complications (OR: 3.74 95% CI: 2.66, 5.26 I ²= 0% p < 0.00001), renal complications (OR: 3.04 95% CI: 1.22, 7.54 I ²= 0% p = 0.02), cardiac complications (OR: 4.33 95% CI: 2.14, 8.77 I ²= 0% p < 0.0001), urinary tract infections (OR: 2.08 95% CI: 1.80, 2.41 I ²= 0% p < 0.00001), and sepsis (OR: 4.95 95% CI: 1.87, 13.08 I ²= 64% p = 0.01) as compared to those with normal albumin.

Conclusion

Hypoalbuminemia is a significant risk factor for complications after spinal degenerative and deformity surgeries. Research is also needed on the role of nutritional support in improving outcomes after spinal degenerative and deformity surgeries.

Systematic Review Registration

https://www.crd.york.ac.uk/prospero/, identifier: CRD42022340024.