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Valeriani E, Pannunzio A, Palumbo IM, Bartimoccia S, Cammisotto V, Castellani V, Porfidia A, Pignatelli P, Violi F. Risk of venous thromboembolism and arterial events in patients with hypoalbuminemia: a comprehensive meta-analysis of more than 2 million patients. J Thromb Haemost 2024; 22:2823-2833. [PMID: 38971499 DOI: 10.1016/j.jtha.2024.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 05/27/2024] [Accepted: 06/18/2024] [Indexed: 07/08/2024]
Abstract
BACKGROUND Albumin has antiplatelet and anticoagulant functions. Hypoalbuminemia, as defined by serum values of <3.5 g/dL, is associated with arterial thrombosis; its impact on venous thromboembolism (VTE) is unclear. OBJECTIVES The objective of this meta-analysis is to assess the VTE risk in patients with hypoalbuminemia. METHODS MEDLINE and EMBASE were searched up to January 2024 for observational studies and randomized trials reporting data of interest. Primary outcome was the risk of VTE, while secondary outcomes were myocardial infarction and stroke risk in patients with hypoalbuminemia versus those without hypoalbuminemia. The risk of bias was evaluated using Newcastle-Ottawa scale and Cochrane tool. Risk ratios (RRs) with 95% confidence intervals (CIs) were calculated in a random-effects model. RESULTS Forty-three studies for a total of 2 531 091 patients (39 738 medical and 2 491 353 surgical) were included in primary analysis; 79.1% of the studies used 3.5 g/dL cut-off value for hypoalbuminemia definition. Follow-up duration was 30 days in 60.5% of studies. Patients with hypoalbuminemia had a higher risk of VTE (RR, 1.88; 95% CI, 1.66-2.13). RRs were similar in both medical (RR, 1.87; 95% CI, 1.53-2.27) and surgical patients (RR, 1.87; 95% CI, 1.61-2.16) and in patients with (RR, 1.86; 95% CI, 1.66-2.10) and without cancer (RR, 1.89; 95% CI, 1.47-2.44). Risk of myocardial infarction (RR, 1.88; 95% CI, 1.54-2.31) and stroke (RR, 1.77; 95% CI, 1.26-2.48) was higher in patients with hypoalbuminemia. CONCLUSION Hypoalbuminemia is a risk factor for VTE in both medical and surgical patients irrespective of cancer coexistence. Serum albumin analysis may represent a simple and cheap tool to identify patients at VTE risk.
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Affiliation(s)
- Emanuele Valeriani
- Department of General Surgery and Surgical Specialty, Sapienza University of Rome, Rome, Italy; Department of Infectious Disease, Azienda Ospedaliero-Universitaria Policlinico Umberto I, Rome, Italy
| | - Arianna Pannunzio
- Department of General Surgery and Surgical Specialty, Sapienza University of Rome, Rome, Italy
| | - Ilaria Maria Palumbo
- Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Simona Bartimoccia
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | - Vittoria Cammisotto
- Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Valentina Castellani
- Department of General Surgery and Surgical Specialty, Sapienza University of Rome, Rome, Italy; Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Angelo Porfidia
- Department of Medicine, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli, Rome, Italy
| | - Pasquale Pignatelli
- Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy; Mediterranea Cardiocentro, Via Orazio, Naples, Italy
| | - Francesco Violi
- Mediterranea Cardiocentro, Via Orazio, Naples, Italy; Sapienza University of Rome, Rome, Italy.
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Hirase T, Taghlabi KM, Cruz-Garza JG, Faraji AH, Marco RAW, Saifi C. Preoperative Serum Albumin Level Predicts Length of Stay and Perioperative Adverse Events Following Vertebral Corpectomy and Posterior Stabilization for Metastatic Spine Disease. Global Spine J 2024; 14:2004-2011. [PMID: 36896896 PMCID: PMC11418719 DOI: 10.1177/21925682231163814] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/11/2023] Open
Abstract
STUDY DESIGN Retrospective review of a prospectively collected national database. OBJECTIVES To determine the association between preoperative serum albumin levels and perioperative adverse events (AEs) following vertebral corpectomy and posterior stabilization for metastatic spine disease. METHODS The 2010 to 2019 American College of Surgeons' National Surgical Quality Improvement (ACS-NSQIP) database was used to identify all patients undergoing vertebral corpectomy and posterior stabilization for metastatic spine disease. Receiver operative characteristic (ROC) curve analysis was used to determine preoperative serum albumin cut-off values for predicting perioperative AEs. Low preoperative serum albumin was defined as serum albumin below this cut-off value. RESULTS A total of 301 patients were included in the study. ROC curve analysis demonstrated serum albumin < 3.25 g/dL as a cut-off value for predicting perioperative AEs. The low serum albumin group had a higher overall perioperative AEs (P = .041), longer post-operative LOS (P < .001), higher 30-day reoperation rate (P = .014), and a higher in-hospital mortality rate (P = .046). Multivariate analysis demonstrated that low preoperative serum albumin was associated with higher perioperative AEs. CONCLUSIONS Low serum albumin level is associated with higher perioperative AEs, longer postoperative LOS, and higher rates of 30-day reoperation and in-hospital mortality among patients undergoing vertebral corpectomy and posterior stabilization for metastatic spine disease. Strategies to improve preoperative nutritional status in patients undergoing this procedure may improve these perioperative outcome measures within this surgical population. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Takashi Hirase
- Department of Orthopedic and Sports Medicine, Houston Methodist Hospital, Houston, TX, USA
| | | | | | - Amir H. Faraji
- Department of Neurosurgery, Houston MethodistHospital, Houston, TX, USA
| | - Rex A. W. Marco
- Department of Orthopedic and Sports Medicine, Houston Methodist Hospital, Houston, TX, USA
| | - Comron Saifi
- Department of Orthopedic and Sports Medicine, Houston Methodist Hospital, Houston, TX, USA
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Xu JR, Kosanam A, Arianpour K, Lamarre ED, Hyland CG, Ciolek PJ. Preoperative Hypoalbuminemia Predicts 30-day Complications in Head and Neck Microvascular Surgery. Laryngoscope 2024. [PMID: 39166736 DOI: 10.1002/lary.31716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 05/28/2024] [Accepted: 08/06/2024] [Indexed: 08/23/2024]
Abstract
INTRODUCTION Hypoalbuminemia, a marker for poor nutritional status, has been associated with postoperative complications, including head and neck cancer surgery. This study investigates the impact of hypoalbuminemia on head and neck microvascular free tissue transfer reconstruction. METHODS This retrospective cohort study queried the 2005-2021 American College of Surgeons National Surgical Quality Improvement Program databases. Reconstructive cases performed by otolaryngologists (CPT: 15756, 15757, 15758, 15842, 20955, 20956, 20957, 20962, 20969, 20970, 20972, 20973, 43116, 43496, 49006, and 49906) with available preoperative albumin, BMI, and age were included. Hypoalbuminemia was defined as a preoperative albumin <3.5 g/dL. Univariate and multivariable logistic regression were performed. RESULTS A total of 3,886 cases met the inclusion criteria, of which 835 (21.5%) had hypoalbuminemia. The hypoalbuminemia cohort was older, had lower BMI, had higher ASA classification, and had worse functional health status. Adjusted multivariable logistic regression showed that hypoalbuminemia was associated with unplanned return to the operating room within 30 days (OR: 1.36, p < 0.01), unplanned reoperation (OR: 1.36, p < 0.01), any complication (OR: 1.77, p < 0.01), surgical complications (OR: 1.94, p < 0.01), and medical complications (OR: 1.34, p = 0.01). Hypoalbuminemia was correlated with a longer hospital stay, superficial surgical site infection, wound dehiscence, transfusion, deep vein thrombosis, and acute renal failure. CONCLUSION Hypoalbuminemia is a risk factor for postoperative complications after microvascular free tissue transfer for head and neck reconstruction. This study suggests that preoperative optimization of hypoalbuminemia may be beneficial for these patients. LEVEL OF EVIDENCE 3 Laryngoscope, 2024.
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Affiliation(s)
- James R Xu
- Case Western Reserve University School of Medicine, Cleveland, Ohio, U.S.A
- Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio, U.S.A
| | - Anish Kosanam
- Case Western Reserve University School of Medicine, Cleveland, Ohio, U.S.A
- Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio, U.S.A
| | | | - Eric D Lamarre
- Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio, U.S.A
| | | | - Peter J Ciolek
- Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio, U.S.A
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Ton A, Wishart D, Ball JR, Shah I, Murakami K, Ordon MP, Alluri RK, Hah R, Safaee MM. The Evolution of Risk Assessment in Spine Surgery: A Narrative Review. World Neurosurg 2024; 188:1-14. [PMID: 38677646 DOI: 10.1016/j.wneu.2024.04.117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Revised: 04/17/2024] [Accepted: 04/18/2024] [Indexed: 04/29/2024]
Abstract
BACKGROUND Risk assessment is critically important in elective and high-risk interventions, particularly spine surgery. This narrative review describes the evolution of risk assessment from the earliest instruments focused on general surgical risk stratification, to more accurate and spine-specific risk calculators that quantified risk, to the current era of big data. METHODS The PubMed and SCOPUS databases were queried on October 11, 2023 using search terms to identify risk assessment tools (RATs) in spine surgery. A total of 108 manuscripts were included after screening with full-text review using the following inclusion criteria: 1) study population of adult spine surgical patients, 2) studies describing validation and subsequent performance of preoperative RATs, and 3) studies published in English. RESULTS Early RATs provided stratified patients into broad categories and allowed for improved communication between physicians. Subsequent risk calculators attempted to quantify risk by estimating general outcomes such as mortality, but then evolved to estimate spine-specific surgical complications. The integration of novel concepts such as invasiveness, frailty, genetic biomarkers, and sarcopenia led to the development of more sophisticated predictive models that estimate the risk of spine-specific complications and long-term outcomes. CONCLUSIONS RATs have undergone a transformative shift from generalized risk stratification to quantitative predictive models. The next generation of tools will likely involve integration of radiographic and genetic biomarkers, machine learning, and artificial intelligence to improve the accuracy of these models and better inform patients, surgeons, and payers.
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Affiliation(s)
- Andy Ton
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Danielle Wishart
- Department of Orthopedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Jacob R Ball
- Department of Orthopedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Ishan Shah
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Kiley Murakami
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Matthew P Ordon
- Department of Orthopedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - R Kiran Alluri
- Department of Orthopedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Raymond Hah
- Department of Orthopedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Michael M Safaee
- Department of Neurological Surgery, Keck School of MedicineUniversity of Southern California, Los Angeles, California, USA.
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Panayi AC, Knoedler L, Matar DY, Rühl J, Friedrich S, Haug V, Palackic A, Thomas B, Kneser U, Orgill DP, Hundeshagen G. The combined risk predictive power of frailty and hypoalbuminemia in free tissue flap reconstruction: A cohort study of 34,571 patients from the NSQIP database. Microsurgery 2024; 44:e31156. [PMID: 38549404 DOI: 10.1002/micr.31156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 12/19/2023] [Accepted: 02/01/2024] [Indexed: 04/02/2024]
Abstract
INTRODUCTION Significant morbidity and mortality are hallmarks of the functional decline seen in physically frail patients. The modified frailty index 5 (mFI-5) represents a risk predictor score that has been validated as a comorbidity-based scale in surgery. Serum albumin levels of <3.5 g/dL (hypoalbuminemia) have also been implicated with poor postoperative outcomes. However, the association between these two parameters remains to be investigated. We aimed to elucidate the interdependence of preoperative albumin levels and frailty, as evaluated by the mFI-5 score, and its reliability to prognosticate postoperative results in free flap reconstruction (FFR). METHODS We conducted a multicenter, retrospective cohort study and accessed the ACS National Surgical Quality Improvement Program (ACS-NSQIP) from 2008 to 2021. We identified all adult patients (≥18 years of age) who underwent a FFR. We extracted perioperative data and lab values including albumin. Multivariable linear and logistic regression analyses were performed to identify independent risk predictors. Main outcomes involved mortality, length of hospital stay, reoperation, medical and surgical complications, and discharge destination within the 30-day postoperative period. RESULTS A total of 34,571 patients were included in the study, with an average age of 53.9 years (standard deviation [SD] 12.2) and an average body mass index (BMI) of 28.8 (SD 6.1). Of these patients, 7484 were male (21.6%), whereas 22,363 (64.7%) had no frailty (mFI = 0). Additionally, 9466 patients had a frailty score of 1 (27.4%), 2505 had a score of 2 (7.2%), 226 had a score of 3 (0.7%), and 11 had a score of 4 or higher (0.0%). Albumin levels were available for 16,250 patients (47.0%), and among them, 1334 (8.2%) had hypoalbuminemia. Regression analyses showed that higher mFI scores were independent predictors of any, surgical, and medical complications, as well as increased rates of reoperations, unplanned readmissions, and prolonged hospital stays. Hypoalbuminemia independently predicted any, surgical, and medical complications, and higher mortality, reoperation, and longer hospital stay. When both frailty and albumin levels (mFI-5 and albumin) were considered together, this combined assessment was found to be a more accurate predictor of all major outcomes (any, medical and surgical complications, mortality, and reoperation). Further, our analysis identified a weak negative correlation between serum albumin levels and mFI scores (Spearman R: -.1; p < .0001). CONCLUSION In conclusion, this cohort study highlights the association of hypoalbuminemia with adverse postoperative outcomes, including those not directly related to frailty. Simultaneously, higher mFI scores independently predicted outcomes not associated with hypoalbuminemia. Stemming from these findings, we recommend considering both serum albumin levels and frailty in patients receiving FFR. This perioperative algorithm may help provide more individualized planning including multidisciplinary care and pre and posthabilitation.
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Affiliation(s)
- Adriana C Panayi
- Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Leonard Knoedler
- Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
| | - Dany Y Matar
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Division of of Plastic Surgery, Department of Surgery, Baltimore, Maryland, USA
| | - Jasmin Rühl
- Department of Mathematical Statistics and Artificial Intelligence in Medicine, Augsburg University, Augsburg, Germany
| | - Sarah Friedrich
- Department of Mathematical Statistics and Artificial Intelligence in Medicine, Augsburg University, Augsburg, Germany
- Centre for Advanced Analytics and Predictive Sciences (CAAPS), Augsburg University, Augsburg, Germany
| | - Valentin Haug
- Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Alen Palackic
- Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
| | - Benjamin Thomas
- Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
| | - Ulrich Kneser
- Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
| | - Dennis P Orgill
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Gabriel Hundeshagen
- Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
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Patel NS, Herzog I, Vought R, Merchant AM. Hypoalbuminemia improves the ACS-NSQIP surgical risk calculator for gastrectomy. Am J Surg 2024; 229:121-128. [PMID: 38151413 DOI: 10.1016/j.amjsurg.2023.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 11/13/2023] [Accepted: 12/09/2023] [Indexed: 12/29/2023]
Abstract
BACKGROUND The ACS-NSQIP Surgical Risk Calculator (SRC) is used to predict surgical outcomes, but its accuracy in gastrectomy has been questioned.1,2 We investigated if adding hypoalbuminemia enhances its predictive ability in gastrectomy. METHODS We identified gastrectomy patients from the ACS-NSQIP database from 2005 to 2019. We constructed pairs of logistic regression models: one with the existing 21 preoperative risk factors from the SRC and another with the addition of hypoalbuminemia. We evaluated improvement using Likelihood Ratio Test (LRT), Brier scores, and c-statistics. RESULTS Of 18,070 gastrectomy patients, 34.5 % had hypoalbuminemia. Hypoalbuminemia patients had 2.34 higher odds of mortality and 1.79 higher odds of morbidity. Adding hypoalbuminemia to the RC model statistically improved predictions for mortality, cumulative morbidity, pulmonary, renal, and wound complications (LRT p < 0.001). It did not improve predictions for cardiac complications (LRT p = 0.11) CONCLUSION: Hypoalbuminemia should be considered as an additional variable to the ACS-NSQIP SRC for gastrectomy.
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Affiliation(s)
- Nikita S Patel
- Rutgers New Jersey Medical School, 185 West Orange Ave, Newark, NJ, 07103, USA
| | - Isabel Herzog
- Rutgers New Jersey Medical School, 185 West Orange Ave, Newark, NJ, 07103, USA
| | - Rita Vought
- Rutgers New Jersey Medical School, 185 West Orange Ave, Newark, NJ, 07103, USA
| | - Aziz M Merchant
- Department of Surgery, Division of General Surgery, Hackensack Meridian School of Medicine, JFK University Medical Center, 102 James Street, Suite 301, Edison, NJ, 08820, USA.
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De la Garza Ramos R, Ryvlin J, Hamad MK, Fourman MS, Eleswarapu A, Gelfand Y, Murthy SG, Shin JH, Yassari R. The prognostic nutritional index (PNI) is independently associated with 90-day and 12-month mortality after metastatic spinal tumor surgery. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:4328-4334. [PMID: 37700182 DOI: 10.1007/s00586-023-07930-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 07/25/2023] [Accepted: 08/28/2023] [Indexed: 09/14/2023]
Abstract
INTRODUCTION Estimated postoperative survival is an important consideration during the decision-making process for patients with spinal metastases. Nutritional status has been associated with poor outcomes and limited survival in the general cancer population. The objective of this study was to evaluate the predictive utility of the prognostic nutritional index (PNI) for postoperative mortality after spinal metastasis surgery. METHODS A total of 139 patients who underwent oncologic surgery for spinal metastases between April 2012 and August 2022 and had a minimum 90-day follow-up were included. PNI was calculated using preoperative serum albumin and total lymphocyte count, with PNI < 40 defined as low. The mean PNI of our cohort was 43 (standard deviation: 7.7). The primary endpoint was 90-day mortality, and the secondary endpoint was 12-month mortality. Multivariate logistic regression analyses were performed. RESULTS The 90-day mortality was 27% (37/139), and the 12-month mortality was 56% (51/91). After controlling for age, ECOG performance status, total psoas muscle cross-sectional area (TPA), and primary cancer site, the PNI was associated with 90-day mortality [odds ratio 0.86 (95% confidence interval 0.79-0.94); p = 0.001]. After controlling for ECOG performance status and primary cancer site, the PNI was associated with 12-month mortality [OR 0.89 (95% CI 0.82-0.97); p = 0.008]. Patients with a low PNI had a 50% mortality rate at 90 days and an 84% mortality rate at 12 months. CONCLUSION The PNI was independently associated with 90-day and 12-month mortality after metastatic spinal tumor surgery, independent of performance status, TPA, and primary cancer site.
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Affiliation(s)
- Rafael De la Garza Ramos
- Spine Research Group, Montefiore Medical Center, Albert Einstein College of Medicine, 3316 Rochambeau Avenue, 3rd Floor, Bronx, NY, 10467, USA.
- Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
| | - Jessica Ryvlin
- Spine Research Group, Montefiore Medical Center, Albert Einstein College of Medicine, 3316 Rochambeau Avenue, 3rd Floor, Bronx, NY, 10467, USA
| | - Mousa K Hamad
- Spine Research Group, Montefiore Medical Center, Albert Einstein College of Medicine, 3316 Rochambeau Avenue, 3rd Floor, Bronx, NY, 10467, USA
- Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Mitchell S Fourman
- Spine Research Group, Montefiore Medical Center, Albert Einstein College of Medicine, 3316 Rochambeau Avenue, 3rd Floor, Bronx, NY, 10467, USA
- Department of Orthopedic Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Ananth Eleswarapu
- Spine Research Group, Montefiore Medical Center, Albert Einstein College of Medicine, 3316 Rochambeau Avenue, 3rd Floor, Bronx, NY, 10467, USA
- Department of Orthopedic Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Yaroslav Gelfand
- Spine Research Group, Montefiore Medical Center, Albert Einstein College of Medicine, 3316 Rochambeau Avenue, 3rd Floor, Bronx, NY, 10467, USA
- Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Saikiran G Murthy
- Spine Research Group, Montefiore Medical Center, Albert Einstein College of Medicine, 3316 Rochambeau Avenue, 3rd Floor, Bronx, NY, 10467, USA
- Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - John H Shin
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Reza Yassari
- Spine Research Group, Montefiore Medical Center, Albert Einstein College of Medicine, 3316 Rochambeau Avenue, 3rd Floor, Bronx, NY, 10467, USA
- Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
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Kang SW, Jo HG, Kim D, Jeong K, Lee J, Lee HJ, Yang S, Park S, Rhie SJ, Chung EK. Population pharmacokinetics and model-based dosing optimization of teicoplanin in elderly critically ill patients with pneumonia. J Crit Care 2023; 78:154402. [PMID: 37634293 DOI: 10.1016/j.jcrc.2023.154402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 08/15/2023] [Accepted: 08/17/2023] [Indexed: 08/29/2023]
Abstract
PURPOSE To evaluate the population pharmacokinetics and pharmacodynamics of teicoplanin in elderly critically ill patients with pneumonia for optimal dosages. METHODS Fifteen critically ill patients (9 men) ≥ 60 years received teicoplanin 6 mg/kg for three doses followed by standard maintenance doses (6 mg/kg q24h) with renal dosing adjustment. Serial plasma samples from all patients were analyzed simultaneously by population pharmacokinetic modeling using NONMEM. Probability of target attainment (PTA) was calculated through Monte Carlo simulations for various dosing regimens to achieve adequate systemic exposures. RESULTS The median (interquartile range, IQR) age, body mass index, and creatinine clearance (CrCl) was 75 (64-78) years, 22.5 (20.8-25.4) kg/m2, and 64 (47-106) mL/min, respectively. The median (IQR) peak and trough concentration was 46.5 (42.7-51.0) and 8.7 (7.2-9.5) mg/L. The population pharmacokinetic model showed slower clearance (CL) and larger peripheral volume of distribution (V2) in patients with reduced CrCl: CL (L/h) = 0.629 × (CrCl/64)0.656, V2 (L) = 55.7 × (CrCl/64)-0.665. Model-based simulations showed PTAs ≥85% only for higher-dose regimens (12 mg/kg) up to an MIC of 0.5 mg/L. CONCLUSIONS Standard teicoplanin dosages for pneumonia may provide inadequate systemic exposures in elderly critically ill patients. High-dose regimens should be considered as empiric therapy or for less susceptible pathogens.
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Affiliation(s)
- Sung Wook Kang
- Department of Pulmonary and Critical Care Medicine, Kyung Hee University Hospital at Gangdong, Seoul 05278, Republic of Korea
| | - Hyeong Geun Jo
- Department of Pharmacy, College of Pharmacy, Kyung Hee University, Seoul 02447, Republic of Korea
| | - Donghyun Kim
- Department of Pharmacy, College of Pharmacy, Kyung Hee University, Seoul 02447, Republic of Korea; Department of Regulatory Science, College of Pharmacy, Graduate School, Kyung Hee University, Seoul 02447, Republic of Korea; Institute of Regulatory Innovation through Science (IRIS), Kyung Hee University, Seoul 02447, Republic of Korea
| | - Kyeoul Jeong
- Department of Pharmacy, College of Pharmacy, Kyung Hee University, Seoul 02447, Republic of Korea
| | - Jaeok Lee
- College of Pharmacy, Ewha Womans University, Seoul 03760, Republic of Korea; Graduate School of Pharmaceutical Sciences, Ewha Womans University, Seoul 03760, Republic of Korea
| | - Hwa Jeong Lee
- College of Pharmacy, Ewha Womans University, Seoul 03760, Republic of Korea; Graduate School of Pharmaceutical Sciences, Ewha Womans University, Seoul 03760, Republic of Korea
| | - Seungwon Yang
- Department of Pharmacy, College of Pharmacy, Kyung Hee University, Seoul 02447, Republic of Korea; Department of Regulatory Science, College of Pharmacy, Graduate School, Kyung Hee University, Seoul 02447, Republic of Korea; Institute of Regulatory Innovation through Science (IRIS), Kyung Hee University, Seoul 02447, Republic of Korea
| | - Sohyun Park
- Graduate School of Pharmaceutical Sciences, Ewha Womans University, Seoul 03760, Republic of Korea; Department of Pharmacy, National Medical Center, Seoul 04564, Republic of Korea
| | - Sandy Jeong Rhie
- College of Pharmacy, Ewha Womans University, Seoul 03760, Republic of Korea; Graduate School of Pharmaceutical Sciences, Ewha Womans University, Seoul 03760, Republic of Korea.
| | - Eun Kyoung Chung
- Department of Pharmacy, College of Pharmacy, Kyung Hee University, Seoul 02447, Republic of Korea; Department of Regulatory Science, College of Pharmacy, Graduate School, Kyung Hee University, Seoul 02447, Republic of Korea; Institute of Regulatory Innovation through Science (IRIS), Kyung Hee University, Seoul 02447, Republic of Korea; Department of Pharmacy, Kyung Hee University Hospital at Gangdong, Seoul 05278, Republic of Korea.
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De la Garza Ramos R, Ryvlin J, Hamad MK, Wang B, Gelfand Y, Murthy S, Yassari R. Performance assessment and external validation of specific thresholds of total psoas muscle cross-sectional area as predictors of mortality in oncologic spine surgery for spinal metastases. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:1003-1009. [PMID: 36627502 DOI: 10.1007/s00586-022-07517-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 11/11/2022] [Accepted: 12/22/2022] [Indexed: 01/12/2023]
Abstract
PURPOSE The purpose of this study was to assess the utility of low muscle mass (LMM) in predicting 90-day and 12-month mortality after spinal tumor surgery. METHODS We identified 115 patients operated on for spinal metastases between April 2012 and August 2022 who had available perioperative abdominal or lumbar spine CT scans and minimum 90-day follow-up. LMM was defined as a total psoas muscle cross-sectional area (TPA) at the L4 pedicle level less than 10.5 cm2 for men and less than 7.2 cm2 for women based on previously reported thresholds. A secondary analysis was performed by analyzing TPA as a continuous variable. The primary endpoint was 90-day mortality, and the secondary endpoint was 12-month mortality. Multivariate logistic regression analyses were performed. RESULTS The 90-day mortality was 19% for patients without and 42% for patients with LMM (p = 0.010). After multivariate analysis, LMM was not independently associated with increased odds of 90-day mortality (odds ratio 2.16 [95% confidence interval 0.62 to 7.50]; p = 0.223). The 12-month mortality was 45% for patients without and 71% for patients with LMM (p = 0.024). After multivariate analysis, LMM was not independently associated with increased odds of 12-month mortality (OR 1.64 [95% CI 0.46 to 5.86]; p = 0.442). The secondary analysis showed no independent association between TPA and 90-day or 12-month mortality. CONCLUSION Patients with LMM had higher rates of 90-day and 12-month mortality in our study, but this was not independent of other parameters such as performance status, hypoalbuminemia, or primary cancer type.
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Affiliation(s)
- Rafael De la Garza Ramos
- Spine Oncology Study Group, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA. .,Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, 3316 Rochambeau Avenue, 3rd Floor, Bronx, NY, 10467, USA.
| | - Jessica Ryvlin
- Spine Oncology Study Group, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Mousa K Hamad
- Spine Oncology Study Group, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.,Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, 3316 Rochambeau Avenue, 3rd Floor, Bronx, NY, 10467, USA
| | - Benjamin Wang
- Spine Oncology Study Group, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Yaroslav Gelfand
- Spine Oncology Study Group, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.,Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, 3316 Rochambeau Avenue, 3rd Floor, Bronx, NY, 10467, USA
| | - Saikiran Murthy
- Spine Oncology Study Group, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.,Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, 3316 Rochambeau Avenue, 3rd Floor, Bronx, NY, 10467, USA
| | - Reza Yassari
- Spine Oncology Study Group, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.,Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, 3316 Rochambeau Avenue, 3rd Floor, Bronx, NY, 10467, USA
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10
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Christina NM, Tjahyanto T, Lie JG, Santoso TA, Albertus H, Octavianus D, Putri DAUI, Andrew J, Jatinugroho YD, Shiady C, Wijaya JH. Hypoalbuminemia and colorectal cancer patients: Any correlation?: A systematic review and meta-analysis. Medicine (Baltimore) 2023; 102:e32938. [PMID: 36827017 PMCID: PMC10162791 DOI: 10.1097/md.0000000000032938] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 01/23/2023] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND In malnourished patients with colorectal cancer, hypoalbuminemia is common and was proposed to determine the postoperative outcome of colorectal surgery. Mounting articles published but have not been evaluated. We aim to assess the predictive value of preoperative hypoalbuminemia in patients undergoing colorectal surgery. METHODS We performed a literature search from PubMed, Euro PMC, and Cochrane with the terms serum albumin, hypoalbuminemia, prognosis, outcome, colorectal cancer, and neoplasm. We also hand-searched and included any relevant papers. Hypoalbuminemia is defined as plasma albumin level < 3.5 mg/dL. We restricted the included studies to English language and adults undergoing colectomy, laparotomy, laparoscopy, or abdominoperineal resection. Any types of articles were included, except an abstract-only publication and those that did not report the key exposure or outcome of interest. The key exposures were mortality, hospitalization time, and morbid conditions (thrombosis, surgical site infection, sepsis, and wound events). We pooled the odds ratio from each included literature as effect size. The Newcastle Ottawa scale and GRADE were used to determine the quality of each included study. RESULTS Hereof 7 observational studies (236,480 individuals) were included. Our meta-analysis found that preoperative hypoalbuminemia can predict the postoperative outcome in colorectal cancer patients. Individuals with hypoalbuminemia were not associated with 30-day mortality (risk ratio [RR] 2.05 [0.72, 5.86], P = .18, I2 = 99%) but were associated with morbidity (RR 2.28 [1.78, 2.93], P < .00001, I2 = 87.5%), surgical complication (RR 1.69 [1.34, 2.13], P < .00001, I2 = 98%), and hospitalization (RR 2.21 [1.93, 2.52], P < .00001, I2 = 0%). According to newcastle ottawa scale, the included studies are of moderate to sound quality. CONCLUSIONS The current systematic review and meta-analysis showed that preoperative hypoalbuminemia was significantly associated with morbidity, length of stay, and surgical complication but not mortality.
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Affiliation(s)
| | - Teddy Tjahyanto
- Department of Medicine, Universitas Tarumanagara, Jakarta, Indonesia
| | - Jason Gunawan Lie
- Department of Medicine, Universitas Tarumanagara, Jakarta, Indonesia
| | | | - Hans Albertus
- Department of Surgery, Universitas Pelita Harapan, Tangerang, Banten, Indonesia
| | - Daniel Octavianus
- Department of Medicine, Universitas Tarumanagara, Jakarta, Indonesia
| | | | - Johanes Andrew
- Department of Medicine, Universitas Tarumanagara, Jakarta, Indonesia
| | | | - Christian Shiady
- Department of Medicine, Universitas Tarumanagara, Jakarta, Indonesia
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11
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Li X, Li H, Huang S, Pan Y. Association between hypoalbuminemia and complications after degenerative and deformity-correcting spinal surgeries: A systematic review and meta-analysis. Front Surg 2023; 9:1030539. [PMID: 36684211 PMCID: PMC9852605 DOI: 10.3389/fsurg.2022.1030539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 11/14/2022] [Indexed: 01/07/2023] Open
Abstract
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.
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Affiliation(s)
- Xia Li
- Department of Orthopedics Nursing, First Affiliated Hospital of Huzhou University, Huzhou, China
| | - Haidong Li
- Department of Orthopedics, First Affiliated Hospital of Huzhou University, Huzhou, China
| | - Shufeng Huang
- Department of Orthopedics, First Affiliated Hospital of Huzhou University, Huzhou, China
| | - Yiping Pan
- Department of Orthopedics Nursing, First Affiliated Hospital of Huzhou University, Huzhou, China,Correspondence: Yiping Pan
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12
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Camino-Willhuber G, Oyadomari S, Ochoa J, Holc F, Guiroy A, Bow H, Hashmi S, Oh M, Bhatia N, Lee YP. The impact of stratified hypoalbuminemia and dialysis on morbidity/mortality after posterior spinal fusion surgery: An ACS-NSQIP study. Surg Neurol Int 2022; 13:359. [PMID: 36128104 PMCID: PMC9479602 DOI: 10.25259/sni_641_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 07/27/2022] [Indexed: 11/04/2022] Open
Abstract
Background:
Preoperative optimization in patients undergoing posterior spinal fusion is essential to limit the number and severity of postoperative complications. Here, we, additionally, evaluated the impact of hypoalbuminemia on morbidity and mortality after posterior spinal fusion surgery.
Methods:
This retrospective analysis was performed using data from a prospective multicentric database (ACSNSQIP:2015–2020) regarding patients undergoing posterior spinal fusions. Factors studied included; baseline demographics and 30-day postoperative complications (i.e., reoperations, readmissions, and mortality rates).
Results:
There were 6805 patients who met the inclusion criteria. They averaged 62 years of age and had an average BMI of 30.2. Within the 30-day postoperative period, 634 (9.3%) sustained complications; 467 (6.9%) were readmitted, 263 (3.9%) required reoperations, and 37 (0.5%) expired. Although multiple preoperative risk factors were analyzed, hypoalbuminemia, severe hypoalbuminemia, and dialysis were the strongest independent risk factors associated with complications (i.e., reoperations, readmissions, and mortality).
Conclusion:
Hypoalbuminemia, severe hypoalbuminemia, and dialysis were significant predictors for morbidity and mortality after posterior spinal fusion surgery.
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Affiliation(s)
- Gaston Camino-Willhuber
- Department of Orthopedic Surgery, Institute of Orthopedics “Carlos E. Ottolenghi,” Hospital Italiano de Buenos Aires, Buenos Aires, Argentina,
| | - Sarah Oyadomari
- Department of Orthopaedics, University of California, Irvine, California, United States,
| | - Jonathan Ochoa
- Department of Orthopaedics, University of California, Irvine, California, United States,
| | - Fernando Holc
- Department of Orthopedic Surgery, Institute of Orthopedics “Carlos E. Ottolenghi,” Hospital Italiano de Buenos Aires, Buenos Aires, Argentina,
| | - Alfredo Guiroy
- Department of Orthopedics, Hospital Español de Mendoza, Mendoza, Argentina,
| | - Hansen Bow
- Department of Neurosurgery, University of California, Irvine, California, United States
| | - Sohaib Hashmi
- Department of Orthopaedics, University of California, Irvine, California, United States,
| | - Michael Oh
- Department of Neurosurgery, University of California, Irvine, California, United States
| | - Nitin Bhatia
- Department of Orthopaedics, University of California, Irvine, California, United States,
| | - Yu-po Lee
- Department of Orthopaedics, University of California, Irvine, California, United States,
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13
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Lemdani MS, Choudhry HS, Patel AM, Ahmad M, Patel R, Patel P, Eloy JA. Malnutrition and Postoperative Outcomes Following Transcervical Zenker Diverticulectomy. Laryngoscope 2022; 133:1402-1408. [PMID: 35869847 DOI: 10.1002/lary.30309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 06/13/2022] [Accepted: 07/07/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVES Hypoalbuminemia has been used as a proxy for poor nutrition, and has been associated with poor postoperative outcomes in varying surgical procedures. This study investigates the association between albumin status and complications following transcervical Zenker diverticulectomy. STUDY DESIGN Retrospective database review. METHODS The National Surgical Quality Improvement Program database was queried for patients who underwent transcervical Zenker diverticulectomy between 2005 and 2018. Univariate and multivariable analyses were conducted to determine associations between albumin status and postoperative complications. RESULTS 318 patients undergoing transcervical Zenker diverticulectomy with available albumin values were queried. The mean serum albumin was 3.90 g/dL (SD = 0.56). Univariate analysis showed that hypoalbuminemia was associated with increased age (77.68 vs. 70.03 years) and female gender (54.4% vs. 45.6%), as well as sepsis (p = 0.045), reintubation (p = 0.040), urinary tract infection (p = 0.017), any medical complication (p < 0.001), any life-threatening complication (p = 0.017), and mortality (p = 0.012). Multivariable analyses found no associations between hypoalbuminemia and mortality (OR 33.136, 95% CI N/A, p = 1.000), any medical complication (OR 1.154, 95% CI 0.326-4.079, p = 0.824), any life-threatening complication (OR 0.604, 95% CI 0.079-4.586, p = 0.604), and length of stay (p = 0.249). CONCLUSIONS This study suggests no association between hypoalbuminemia and postoperative complications in transcervical Zenker diverticulectomy. Hypoalbuminemia and malnutrition may not be a contraindication for surgery correcting Zenker diverticulectomy. LEVEL OF EVIDENCE 4 Laryngoscope, 133:1402-1408, 2023.
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Affiliation(s)
- Mehdi S. Lemdani
- Department of Otolaryngology – Head and Neck Surgery Rutgers New Jersey Medical School Newark New Jersey USA
| | - Hannaan S. Choudhry
- Department of Otolaryngology – Head and Neck Surgery Rutgers New Jersey Medical School Newark New Jersey USA
| | - Aman M. Patel
- Department of Otolaryngology – Head and Neck Surgery Rutgers New Jersey Medical School Newark New Jersey USA
| | - Maham Ahmad
- Department of Otolaryngology – Head and Neck Surgery Rutgers New Jersey Medical School Newark New Jersey USA
| | - Rushi Patel
- Department of Otolaryngology – Head and Neck Surgery Rutgers New Jersey Medical School Newark New Jersey USA
| | - Prayag Patel
- Department of Otolaryngology – Head and Neck Surgery Rutgers New Jersey Medical School Newark New Jersey USA
| | - Jean Anderson Eloy
- Department of Otolaryngology – Head and Neck Surgery Rutgers New Jersey Medical School Newark New Jersey USA
- Center for Skull Base and Pituitary Surgery Neurological Institute of New Jersey, Rutgers New Jersey Medical School Newark New Jersey USA
- Department of Neurological Surgery Rutgers New Jersey Medical School Newark New Jersey USA
- Department of Ophthalmology and Visual Science Rutgers New Jersey Medical School Newark New Jersey USA
- Department of Otolaryngology and Facial Plastic Surgery Saint Barnabas Medical Center ‐ RWJBarnabas Health Livingston New Jersey USA
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