Poor Nutrition Status and Lumbar Spine Fusion Surgery in the Elderly: Readmissions, Complications, and Mortality.
METHODS
Retrospective database review.


OBJECTIVE
To quantify the medical and surgical risks associated with elective lumbar spine fusion surgery in patients with poor preoperative nutritional status and to assess how nutritional status alters length of stay and readmission rates.


BACKGROUND
There has been recent interest in quantifying the increased risk of complications caused by frailty, an important consideration in elderly patients that is directly related to comorbidity burden. Preoperative nutritional status is an important contributor to both sarcopenia and frailty and is poorly studied in the elderly spine surgery population.


METHODS
The full 100% sample of Medicare data from 2005 to 2012 were utilized to select all patients 65 to 84 years old who underwent elective 1 to 2 level posterior lumbar fusion for degenerative pathology. Patients with diagnoses of poor nutritional status within the 3 months preceding surgery were selected and compared with a control cohort. Outcomes that were assessed included major medical complications, infection, wound dehiscence, and mortality. In addition, readmission rates and length of stay were evaluated.


RESULTS
When adjusting for demographics and comorbidities, malnutrition was determined to result in significantly increased odds of both 90-day major medical complications (adjusted odds ratio, OR: 4.24) and 1-year mortality (adjusted OR: 6.16). Multivariate analysis also demonstrated that malnutrition was a significant predictor of increased infection (adjusted OR: 2.27) and wound dehiscence (adjusted OR: 2.52) risk. Length of stay was higher in malnourished patients, though 30-day readmission rates were similar to controls.


CONCLUSIONS
Malnutrition significantly increases complication and mortality rates, whereas also significantly increasing length of stay. Nutritional supplementation before surgery should be considered to optimize postoperative outcomes in malnourished individuals.


METHODS
3.
Department of Orthopedic Surgery, Johns Hopkins Hospital, Baltimore, MD.
Varun
V
Puvanesarajah
Department of Orthopedic Surgery, Johns Hopkins Hospital, Baltimore, MD.
Amit
A
Jain
Department of Orthopedic Surgery, Johns Hopkins Hospital, Baltimore, MD.
Khaled
K
Kebaish
Department of Neurosurgery, University of Virginia, Charlottesville, VA.
Christopher I
CI
Shaffrey
Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, MD.
Daniel M
DM
Sciubba
Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, MD.
Rafael
R
De la Garza-Ramos
Department of Orthopedic Surgery, Johns Hopkins Hospital, Baltimore, MD.
Akhil Jay
AJ
Khanna
Department of Orthopedic Surgery, University of Virginia, Charlottesville, VA.
Hamid
H
Hassanzadeh
D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D044342:Malnutrition / Q000175:diagnosis / Q000401:mortality*; D006278:Medicare / Q000639:trends; D009026:Mortality / Q000639:trends; D009752:Nutritional Status / Q000502:physiology*; D010359:Patient Readmission / Q000639:trends; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology / Q000401:mortality*; D012189:Retrospective Studies; D012307:Risk Factors; D013123:Spinal Fusion / Q000009:adverse effects / Q000401:mortality* / Q000639:trends; D014481:United States / Q000453:epidemiology