Association between a prognostic nutritional index less than 50 and the risk of medical complications after adult spinal deformity surgery

View More View Less
  • 1 Department of Orthopedic Surgery and Division of Geriatric Musculoskeletal Health, Hamamatsu University School of Medicine;
  • 2 Department of Orthopedic Surgery, Hamamatsu University School of Medicine; and
  • 3 Department of Orthopedic Surgery, Hamamatsu Medical Center, Hamamatsu, Shizuoka, Japan
Restricted access

Purchase Now

USD  $45.00

Spine - 1 year subscription bundle (Individuals Only)

USD  $369.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00
Print or Print + Online

OBJECTIVE

Many complications are likely to occur in patients with malnutrition. The prognostic nutritional index (PNI) is often used when evaluating a patient’s nutritional condition. However, no studies have investigated the association between nutritional status and postoperative medical complications or prognosis by using the PNI in the field of spinal surgery. The purpose of this retrospective study was to investigate postoperative medical complications and prognoses of patients who had undergone adult spinal deformity (ASD) surgery, according to their preoperative nutritional status.

METHODS

All patients aged ≥ 40 years who had undergone scheduled ASD surgery in the authors’ hospital between March 2010 and June 2017 were eligible for study inclusion and were divided into groups according to their PNI (< 50, group L; ≥ 50, group H). Medical complications diagnosed within 30 days postoperatively were evaluated; however, surgical site infection and death were evaluated until 1 and 5 years after surgery, respectively.

RESULTS

Among the 285 eligible patients, groups L and H consisted of 118 and 167 patients, whose mean ages were 68.6 and 68.3 years, respectively. There was a significant difference in body mass index (22 vs 24 mg/kg2, respectively, p = 0.000), PNI (46 vs 55, p = 0.000), comorbidity of osteoporosis (50% vs 32%, p = 0.005) and autoimmune disease (13% vs 5%, p = 0.036), medical history of malignant disorder (17% vs 6%, p = 0.007), and medical complications (49% vs 23%, p = 0.000) between groups L and H. Multiple logistic regression analysis suggested that significant risk factors for postoperative medical complications were male sex (p = 0.000, OR 3.5, 95% CI 1.78–6.96), PNI < 50 (p = 0.000, OR 2.9, 95% CI 1.69–4.93), and days to ambulation (p = 0.003, OR 1.1, 95% CI 1.02–1.09).

CONCLUSIONS

Medical complication rates are significantly higher in patients with PNI < 50, those with delayed ambulation, and male patients. In malnourished patients scheduled for ASD surgery, improvement of preoperative nutritional status and postoperative early ambulation are important to avoid medical complications.

ABBREVIATIONS ASD = adult spinal deformity; AUC = area under the curve; BMI = body mass index; C7-CSVL = C7 plumb line to the central sacral vertical line; CCI = Charlson Comorbidity Index; CL = cervical lordosis; DVT = deep venous thrombosis; LL = lumbar lordosis; PE = pulmonary embolism; PI = pelvic incidence; PNI = prognostic nutritional index; PT = pelvic tilt; ROC = receiver operating characteristic; SSI = surgical site infection; SVA = sagittal vertical axis; TK = thoracic kyphosis; TS = T1 slope.

Spine - 1 year subscription bundle (Individuals Only)

USD  $369.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00

Contributor Notes

Correspondence Shin Oe: Hamamatsu University School of Medicine, Shizuoka, Japan. mecersior@gmail.com.

INCLUDE WHEN CITING Published online March 27, 2020; DOI: 10.3171/2020.1.SPINE191410.

Disclosures Drs. Oe and Yamato belong to the donated fund laboratory called Division of Geriatric Musculoskeletal Health. Dr. Oe has a financial relationship with Medtronic Sofamor Danek Inc., Japan Medical Dynamic Marketing Inc., and Meitoku Medical Institution Jyuzen Memorial Hospital.

  • 1

    Ganai S, Lee KF, Merrill A, . Adverse outcomes of geriatric patients undergoing abdominal surgery who are at high risk for delirium. Arch Surg. 2007;142(11):10721078.

    • Search Google Scholar
    • Export Citation
  • 2

    Oh ES, Li M, Fafowora TM, . Preoperative risk factors for postoperative delirium following hip fracture repair: a systematic review. Int J Geriatr Psychiatry. 2015;30(9):900910.

    • Search Google Scholar
    • Export Citation
  • 3

    Shi C, Yang C, Gao R, Yuan W. Risk factors for delirium after spinal surgery: a meta-analysis. World Neurosurg. 2015;84(5):14661472.

  • 4

    van der Mast RC, van den Broek WW, Fekkes D, . Incidence of and preoperative predictors for delirium after cardiac surgery. J Psychosom Res. 1999;46(5):479483.

    • Search Google Scholar
    • Export Citation
  • 5

    Fu MC, D’Ambrosia C, McLawhorn AS, . Malnutrition increases with obesity and is a stronger independent risk factor for postoperative complications: a propensity-adjusted analysis of total hip arthroplasty patients. J Arthroplasty. 2016;31(11):24152421.

    • Search Google Scholar
    • Export Citation
  • 6

    Fu MC, McLawhorn AS, Padgett DE, Cross MB. Hypoalbuminemia is a better predictor than obesity of complications after total knee arthroplasty: a propensity score-adjusted observational analysis. HSS J. 2017;13(1):6674.

    • Search Google Scholar
    • Export Citation
  • 7

    Nelson CL, Elkassabany NM, Kamath AF, Liu J. Low albumin levels, more than morbid obesity, are associated with complications after TKA. Clin Orthop Relat Res. 2015;473(10):31633172.

    • Search Google Scholar
    • Export Citation
  • 8

    Walls JD, Abraham D, Nelson CL, . Hypoalbuminemia more than morbid obesity is an independent predictor of complications after total hip arthroplasty. J Arthroplasty. 2015;30(12):22902295.

    • Search Google Scholar
    • Export Citation
  • 9

    Bohl DD, Shen MR, Kayupov E, . Is hypoalbuminemia associated with septic failure and acute infection after revision total joint arthroplasty? A study of 4517 patients from the National Surgical Quality Improvement Program. J Arthroplasty. 2016;31(5):963967.

    • Search Google Scholar
    • Export Citation
  • 10

    Burden S, Todd C, Hill J, Lal S. Pre-operative nutrition support in patients undergoing gastrointestinal surgery. Cochrane Database Syst Rev. 2012;11:CD008879.

    • Search Google Scholar
    • Export Citation
  • 11

    Sungurtekin H, Sungurtekin U, Balci C, . The influence of nutritional status on complications after major intraabdominal surgery. J Am Coll Nutr. 2004;23(3):227232.

    • Search Google Scholar
    • Export Citation
  • 12

    Yang Y, Gao P, Song Y, . The prognostic nutritional index is a predictive indicator of prognosis and postoperative complications in gastric cancer: a meta-analysis. Eur J Surg Oncol. 2016;42(8):11761182.

    • Search Google Scholar
    • Export Citation
  • 13

    Strickland A, Brogan A, Krauss J, . Is the use of specialized nutritional formulations a cost-effective strategy? A national database evaluation. JPEN J Parenter Enteral Nutr. 2005;29(1)(suppl):S81S91.

    • Search Google Scholar
    • Export Citation
  • 14

    Hill GL, Blackett RL, Pickford I, . Malnutrition in surgical patients. An unrecognised problem. Lancet. 1977;1(8013):689692.

  • 15

    Oe S, Togawa D, Yamato Y, . Preoperative age and prognostic nutritional index are useful factors for evaluating postoperative delirium among patients with adult spinal deformity. Spine (Phila Pa 1976). 2019;44(7):472478.

    • Search Google Scholar
    • Export Citation
  • 16

    Onodera T, Goseki N, Kosaki G. Prognostic nutritional index in gastrointestinal surgery of malnourished cancer patients [in Japanese]. Nippon Geka Gakkai Zasshi. 1984;85(9):10011005.

    • Search Google Scholar
    • Export Citation
  • 17

    Gusmao-Flores D, Salluh JI, Chalhub RA, Quarantini LC. The confusion assessment method for the intensive care unit (CAM-ICU) and intensive care delirium screening checklist (ICDSC) for the diagnosis of delirium: a systematic review and meta-analysis of clinical studies. Crit Care. 2012;16(4):R115.

    • Search Google Scholar
    • Export Citation
  • 18

    Oh ES, Fong TG, Hshieh TT, Inouye SK. Delirium in older persons: advances in diagnosis and treatment. JAMA. 2017;318(12):11611174.

  • 19

    Weimann A, Braga M, Carli F, . ESPEN guideline: clinical nutrition in surgery. Clin Nutr. 2017;36(3):623650.

  • 20

    Santa Mina D, Clarke H, Ritvo P, . Effect of total-body prehabilitation on postoperative outcomes: a systematic review and meta-analysis. Physiotherapy. 2014;100(3):196207.

    • Search Google Scholar
    • Export Citation
  • 21

    Valkenet K, van de Port IG, Dronkers JJ, . The effects of preoperative exercise therapy on postoperative outcome: a systematic review. Clin Rehabil. 2011;25(2):99111.

    • Search Google Scholar
    • Export Citation
  • 22

    Leslie DL, Zhang Y, Holford TR, . Premature death associated with delirium at 1-year follow-up. Arch Intern Med. 2005;165(14):16571662.

    • Search Google Scholar
    • Export Citation
  • 23

    Fukuda Y, Yamamoto K, Hirao M, . Prevalence of malnutrition among gastric cancer patients undergoing gastrectomy and optimal preoperative nutritional support for preventing surgical site infections. Ann Surg Oncol. 2015;22(suppl 3):S778S785.

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 37 37 37
Full Text Views 12 12 12
PDF Downloads 8 8 8
EPUB Downloads 0 0 0