title: Prealbumin as a serum biomarker of impaired perioperative nutritional status and risk for surgical site infection after spine surgery.
abstract: BACKGROUND
  Impaired perioperative nutritional status has been shown to be an important predictor of surgical morbidity and is the earliest marker of nutritional deficiency. No study, however, has examined serum prealbumin as a surrogate marker of nutritional status in patients undergoing spine surgery.
  
  
  METHODS
  We performed a retrospective review of all patients who developed a postoperative deep wound infection after undergoing spine surgery at the University of Pittsburgh Medical Center from January 2008 through December 2011. Demographics, preoperative diagnosis, type of surgery, perioperative serum prealbumin level, time to infection, number and type of debridement procedures, and length of hospital stay were recorded.
  
  
  RESULTS
  A total of 83 patients had prealbumin levels available at the time of presentation of infection. Mean patient age was 56 years, and 71% were women. Surgical treatment for the infection required between 1 and 13 debridements, and 21 (25%) of the 83 patients who had instrumentation placed at the time of the initial surgery required removal of their instrumentation. Inpatient hospitalizations were extended by an average of 13 days. Prealbumin levels were below normal in 82 (99%) of the 83 patients; levels were < 7 mg/dL in 24 patients, between 7 and 11 mg/dL in 32 patients, and between 11 and 19 mg/dL in 26 patients.
  
  
  CONCLUSIONS
  All patients except one who developed postoperative deep wound infection after spine surgery had serum prealbumin levels in the malnutrition range at the time of presentation. The current study suggests serum prealbumin levels may be an inexpensive screening biomarker for nutritional status and risk stratification for postoperative infection after spine surgery.
authors.affiliation: Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States.
authors.forename: Zachary
authors.initials: Z
authors.lastname: Tempel
authors.affiliation: Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States.
authors.forename: Ramesh
authors.initials: R
authors.lastname: Grandhi
authors.affiliation: Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States.
authors.forename: Matthew
authors.initials: M
authors.lastname: Maserati
authors.affiliation: Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States.
authors.forename: David
authors.initials: D
authors.lastname: Panczykowski
authors.affiliation: Department of General Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States.
authors.forename: Juan
authors.initials: J
authors.lastname: Ochoa
authors.affiliation: Department of Plastic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States.
authors.forename: James
authors.initials: J
authors.lastname: Russavage
authors.affiliation: Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States.
authors.forename: David
authors.initials: D
authors.lastname: Okonkwo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status; D019637:Orthopedic Procedures / Q000009:adverse effects*; D059035:Perioperative Period; D011228:Prealbumin / Q000378:metabolism*; D012189:Retrospective Studies; D012307:Risk Factors; D013131:Spine / Q000601:surgery*; D013530:Surgical Wound Infection / Q000097:blood / Q000209:etiology*; D055815:Young Adult
chemical_list: D015415:Biomarkers; D011228:Prealbumin