PMID- 34781222
OWN - NLM
STAT- MEDLINE
DCOM- 20220322
LR  - 20220322
IS  - 1872-6968 (Electronic)
IS  - 0303-8467 (Linking)
VI  - 211
DP  - 2021 Dec
TI  - Effects of preoperative nutritional status on complications and readmissions 
      after posterior lumbar decompression and fusion for spondylolisthesis: A 
      propensity-score analysis.
PG  - 107017
LID - S0303-8467(21)00546-1 [pii]
LID - 10.1016/j.clineuro.2021.107017 [doi]
AB  - INTRODUCTION: Malnutrition, common in the elderly, may adversely affect 
      healthcare outcomes. In spine surgery, malnutrition is associated with higher 
      rates of perioperative complications, unplanned readmission, and prolonged length 
      of stay (LOS). The aim of this study was to determine the effect of malnutrition 
      on adverse events (AEs), unplanned readmission, and LOS in patients undergoing 
      spine surgery for spondylolisthesis. METHODS: A retrospective cohort study was 
      performed using the American College of Surgeons National Surgical Quality 
      Improvement Program database from 2010 to 2016. Adult patients who underwent 
      posterior decompression or fusion for spondylolisthesis were identified using the 
      ICD-9-CM coding systems. Patients were divided into two cohorts based on 
      preoperative serum albumin levels. propensity-score (PS) matching was used to 
      create an age- and sex-matched Nourished cohort. Patient demographics, 
      comorbidities, LOS, and postoperative complications were collected. Multivariate 
      logistic regression analysis was performed to identify predictors of prolonged 
      LOS, unplanned readmission, and AEs. RESULTS: Of the 2196 patients identified, 
      4.5% were malnourished. Patients in the Malnourished cohort were found to have 
      significantly longer average LOS (Malnourished: 4.51 +/- 3.1 days vs PS-Matched Not 
      Nourished: 3.7 +/- 3.7, p = 0.002), higher rates of AEs (Malnourished: 14.3% vs 
      PS-Matched Nourished: 5.8%, p = 0.007), reoperation (Malnourished: 8.4% vs 
      PS-Matched Nourished: 3.2%, p = 0.026), and unplanned readmission (Malnourished: 
      15.3% vs PS-Matched Nourished: 6.1%, p = 0.003). On multivariate analysis 
      considering only preoperative data, malnutrition was a significant independent 
      predictor of AEs [OR: 2.13, CI (1.02, 4.46), p = 0.045]. However, after 
      correcting for the occurrence of AEs, malnutrition was not associated with total 
      LOS [aRR: 0.29, CI (-0.37, 0.95), p = 0.392] or 30-day unplanned readmissions 
      [aOR: 2.24, CI (0.89, 5.60), p = 0.086]. CONCLUSION: Our study found that 
      malnourished patients undergoing lumbar fusion for spondylolisthesis have 
      significantly higher rates of AEs, unplanned readmission, and prolonged LOS than 
      nourished patients. Further studies are necessary to corroborate our findings.
CI  - Published by Elsevier B.V.
FAU - Elsamadicy, Aladine A
AU  - Elsamadicy AA
AD  - Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, 
      USA. Electronic address: aladine.elsamadicy@yale.edu.
FAU - Havlik, John
AU  - Havlik J
AD  - Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, 
      USA.
FAU - Reeves, Benjamin C
AU  - Reeves BC
AD  - Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, 
      USA.
FAU - Koo, Andrew B
AU  - Koo AB
AD  - Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, 
      USA.
FAU - Sherman, Josiah
AU  - Sherman J
AD  - Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, 
      USA.
FAU - Lo, Sheng-Fu Larry
AU  - Lo SL
AD  - Department of Neurosurgery, Zucker School of Medicine at Hofstra, Long Island 
      Jewish Medical Center and North Shore University Hospital, Northwell Health, 
      Manhasset, NY, USA 11030.
FAU - Shin, John H
AU  - Shin JH
AD  - Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical 
      School, Boston, MA, USA.
FAU - Sciubba, Daniel M
AU  - Sciubba DM
AD  - Department of Neurosurgery, Zucker School of Medicine at Hofstra, Long Island 
      Jewish Medical Center and North Shore University Hospital, Northwell Health, 
      Manhasset, NY, USA 11030.
LA  - eng
PT  - Journal Article
DEP - 20211106
PL  - Netherlands
TA  - Clin Neurol Neurosurg
JT  - Clinical neurology and neurosurgery
JID - 7502039
SB  - IM
MH  - Aged
MH  - Decompression, Surgical/*adverse effects
MH  - Female
MH  - Humans
MH  - Length of Stay
MH  - Lumbar Vertebrae/surgery
MH  - Male
MH  - Malnutrition/*complications
MH  - Middle Aged
MH  - Nutritional Status
MH  - *Patient Readmission
MH  - Postoperative Complications/*epidemiology
MH  - Propensity Score
MH  - Spinal Fusion/*adverse effects
MH  - Spondylolisthesis/*surgery
MH  - Treatment Outcome
OTO - NOTNLM
OT  - Albumin
OT  - Complications
OT  - Fusion
OT  - Malnutrition
OT  - Spondylolisthesis
EDAT- 2021/11/16 06:00
MHDA- 2022/03/23 06:00
CRDT- 2021/11/15 20:26
PHST- 2021/09/21 00:00 [received]
PHST- 2021/10/25 00:00 [revised]
PHST- 2021/10/31 00:00 [accepted]
PHST- 2021/11/16 06:00 [pubmed]
PHST- 2022/03/23 06:00 [medline]
PHST- 2021/11/15 20:26 [entrez]
AID - S0303-8467(21)00546-1 [pii]
AID - 10.1016/j.clineuro.2021.107017 [doi]
PST - ppublish
SO  - Clin Neurol Neurosurg. 2021 Dec;211:107017. doi: 10.1016/j.clineuro.2021.107017. 
      Epub 2021 Nov 6.