title: Association of low perioperative prealbumin level and surgical complications in long-segment spinal fusion patients: A retrospective cohort study.
abstract: BACKGROUND
  Spinal surgery places significant physiological and nutritional burden on the patient. Complications are common and can impact long-term clinical outcomes. Therefore, it is important to identify factors associated with perioperative complications to potentially mitigate the lasting effects on patient outcomes. The significant impact of malnutrition on surgical outcomes has been well established; however, there is a paucity of data in the spine literature. Our objective was to evaluate perioperative prealbumin level in patients undergoing long-segment spinal fusion and its relationship to surgical outcomes and complication rates.
  
  
  METHODS
  Patients who underwent long-segment (≥7) spinal fusions in whom a serum prealbumin level was obtained within 10 days of surgery were identified. Demographic, clinical, operative, and postoperative parameters were examined. Prealbumin levels were dichotomized using a threshold value of 11 mg/dL into low (<11 mg/dL) and high (≥11 mg/dL) groups.
  
  
  RESULTS
  Among the 47 patients identified, the mean prealbumin level was 12.2 mg/dL, with 20 patients (43%) in the low group and 27 (57%) in the high group. Patients with low prealbumin were more likely to undergo a longer fusion (11.6 vs. 9.1 levels, p = 0.003). They were also significantly more likely to develop an infectious complication than those in the high prealbumin group (50% vs. 15%, p = 0.012), most commonly urinary tract infection (9/14, 64%). There was no significant difference in rates of noninfectious complications between the two groups. Multiple binary logistic regression analysis revealed only low prealbumin was significantly associated with postoperative infection (OR 6.673, 95% CI 1.236-36.024).
  
  
  CONCLUSIONS
  Low prealbumin levels were associated with higher rates of infections in patients undergoing long-segment posterior spinal fusion procedures. Further investigations are needed to better define this association and to determine whether effective interventions may be implemented in this subset of patients to attenuate this relationship.
authors.affiliation: Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, 175 N. Medical Drive East, Salt Lake City, UT, 84132, USA.
authors.forename: Jian
authors.initials: J
authors.lastname: Guan
authors.affiliation: Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, 175 N. Medical Drive East, Salt Lake City, UT, 84132, USA.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Holland
authors.affiliation: Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, 175 N. Medical Drive East, Salt Lake City, UT, 84132, USA.
authors.forename: Meic H
authors.initials: MH
authors.lastname: Schmidt
authors.affiliation: Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, 175 N. Medical Drive East, Salt Lake City, UT, 84132, USA.
authors.forename: Andrew T
authors.initials: AT
authors.lastname: Dailey
authors.affiliation: Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, 175 N. Medical Drive East, Salt Lake City, UT, 84132, USA.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Mahan
authors.affiliation: Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, 175 N. Medical Drive East, Salt Lake City, UT, 84132, USA. Electronic address: neuropub@hsc.utah.edu.
authors.forename: Erica F
authors.initials: EF
authors.lastname: Bisson
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D059035:Perioperative Period; D011183:Postoperative Complications / Q000097:blood* / Q000209:etiology; D011228:Prealbumin / Q000032:analysis*; D012189:Retrospective Studies; D012307:Risk Factors; D013123:Spinal Fusion / Q000009:adverse effects* / Q000379:methods
chemical_list: D011228:Prealbumin
keywords: Nutrition; Prealbumin; Spinal fusion; Spinal surgery; Surgical complications