title: Nutritional Status as an Adjunct Risk Factor for Early Postoperative Complications Following Posterior Cervical Fusion.
abstract: METHODS
  Retrospective study on prospectively collected data.
  
  
  OBJECTIVE
  The aim of this study was to study the impact of nutritional status, as measured by serum albumin level, on patient outcomes following posterior cervical fusion (PCF) surgery.
  
  
  BACKGROUND
  Malnutrition is a potential modifiable risk factor that has garnered an increasing amount of attention within orthopedics in recent years. There is evidence to suggest the role of nutritional status in lumbar and ACDF surgery, yet the data for PCF are still lacking.
  
  
  METHODS
  The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) was queried by current procedure terminology (CPT) from 2010 to 2014. Bivariate analyses were performed to compare the preoperative characteristics between those with normal albumin and hypoalbuminemia. Postoperative complications and outcomes were similarly analyzed for those with and without low albumin levels. Stepwise multivariate logistic regression models were employed to determine whether hypoalbuminemia was an independent risk factor for short-term patient outcomes and complications.
  
  
  RESULTS
  There were 1573 cases with measured albumin levels (42.4%). The mean (standard deviation) serum albumin level was 3.9 (0.6). Among these patients, 265 (16.8%) cases had hypoalbuminemia. The adjusted analyses demonstrated that patients with hypoalbuminemia had a significantly higher risk for length of stay >5 days (odds ratio [OR] = 3.8; 95% confidence interval [CI] = 2.8-5.1; P < 0.0001). In addition, hypoalbuminemia was an independent risk factor for any complications (OR = 2.7; 95% CI = 1.9-3.7; P < 0.0001), pulmonary complications (OR = 2.3; 95% CI = 1.2-4.5; P = 0.010), intra/postoperative blood transfusions (OR = 3.2; 95% CI = 2.1-4.9; P < 0.0001), sepsis (OR = 4.0; 95% CI = 1.7-9.2; P = 0.001), and venous thromboemoblism (OR = 3.6; 95% CI = 1.5-8.5; P = 0.004).
  
  
  CONCLUSIONS
  These findings implicate that a baseline serum albumin <3.5 g/dL may serve as a valuable prognostic measure for the development of several complications following PCF surgery.
  
  
  METHODS
  3.
authors.affiliation: Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York NY.
authors.forename: Nathan J
authors.initials: NJ
authors.lastname: Lee
authors.affiliation: Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York NY.
authors.forename: Parth
authors.initials: P
authors.lastname: Kothari
authors.affiliation: Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York NY.
authors.forename: Jun S
authors.initials: JS
authors.lastname: Kim
authors.affiliation: Faculty of Medicine, University of New South Wales (UNSW), Sydney, Australia.|NeuroSpine Surgery Research Group (NSURG), Prince of Wales Private Hospital, Sydney, Australia.
authors.forename: Kevin
authors.initials: K
authors.lastname: Phan
authors.affiliation: Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York NY.
authors.forename: John
authors.initials: J
authors.lastname: Di Capua
authors.affiliation: Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York NY.
authors.forename: John
authors.initials: J
authors.lastname: Shin
authors.affiliation: Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York NY.
authors.forename: Samuel K
authors.initials: SK
authors.lastname: Cho
mesh_terms: D002574:Cervical Vertebrae / Q000601:surgery*; D006801:Humans; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors; D012709:Serum Albumin / Q000032:analysis; D013123:Spinal Fusion / Q000009:adverse effects*
chemical_list: D012709:Serum Albumin