Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York NY.
Faculty of Medicine, University of New South Wales (UNSW), Sydney, Australia.
Spine (Phila Pa 1976). 2017 Sep 15;42(18):1367-1374. doi: 10.1097/BRS.0000000000002119.
Retrospective study on prospectively collected data.
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.
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.
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.
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).
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.
前瞻性收集数据的回顾性研究。
本研究旨在探讨血清白蛋白水平衡量的营养状况对颈椎后路融合（PCF）术后患者结局的影响。
营养不良是一个潜在的可改变的危险因素，近年来在骨科领域受到越来越多的关注。有证据表明营养状况与腰椎和 ACDF 手术有关，但 PCF 的相关数据仍存在空白。
通过当前手术术语（CPT），从 2010 年至 2014 年，查询美国外科医师学会国家手术质量改进计划（ACS NSQIP）。采用双变量分析比较白蛋白正常和低白蛋白血症患者的术前特征。同样对白蛋白水平低和不低的患者的术后并发症和结局进行分析。采用逐步多变量逻辑回归模型来确定低白蛋白血症是否是短期患者结局和并发症的独立危险因素。
有 1573 例患者的白蛋白水平可测（42.4%）。平均（标准差）血清白蛋白水平为 3.9（0.6）。这些患者中，265 例（16.8%）有低白蛋白血症。调整后的分析表明，低白蛋白血症患者的住院时间超过 5 天的风险显著增加（优势比[OR]＝3.8；95%置信区间[CI]＝2.8-5.1；P＜0.0001）。此外，低白蛋白血症是发生任何并发症（OR＝2.7；95% CI＝1.9-3.7；P＜0.0001）、肺部并发症（OR＝2.3；95% CI＝1.2-4.5；P＝0.010）、围手术期输血（OR＝3.2；95% CI＝2.1-4.9；P＜0.0001）、脓毒症（OR＝4.0；95% CI＝1.7-9.2；P＝0.001）和静脉血栓栓塞症（OR＝3.6；95% CI＝1.5-8.5；P＝0.004）的独立危险因素。
这些发现表明，基线血清白蛋白＜3.5 g/dL 可能成为颈椎后路融合术后发生多种并发症的有价值的预后指标。
3 级。
