Department of Orthopedic Surgery, University of California- San Francisco, San Francisco, CA.
Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI.
Spine (Phila Pa 1976). 2018 Mar 15;43(6):454-460. doi: 10.1097/BRS.0000000000002436.
Retrospective database review.
To determine (1) the relationship between hypoalbuminemia and body mass index (BMI); (2) the association between malnutrition and revision spine surgery for septic reasons; and (3) the association between malnutrition and infection after aseptic revision spine surgery.
Although malnutrition has been suggested to increase the risk of infection after spine surgery, evidence supporting this hypothesis is conflicting.
Patients undergoing revision spine surgery were identified in the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) from 2006 to 2014. Hypoalbuminemia (albumin < 3.5 g/dL) was used as a surrogate marker of malnutrition. Multivariate analysis was used to assess the association of hypoalbuminemia with septic versus aseptic revision spine surgery. The association between hypoalbuminemia and deep infection postoperatively within 30 days of aseptic revision surgeries was also assessed.
A total of 3136 patients who underwent revision spine surgery were identified; 2922 (93.2%) underwent surgery for aseptic reasons, and 214 (6.8%) for septic reasons. Hypoalbuminemia was present in all BMI groups including obese patients, though it was highest in underweight patients (22.4%). Patients who underwent surgery for septic reasons had a higher rate of hypoalbuminemia than those undergoing surgery for aseptic reasons (49.1% vs. 8.5%, P < 0.001) with nine times the odds of having hypoalbuminemia (adjusted odds ratio, OR = 9.17, P < 0.001). Of the 2922 patients undergoing revision spine surgery for aseptic reasons, hypoalbuminemia was independently associated with acute deep infection within 30 days of surgery (adjusted OR = 2.85, P = 0.019).
Malnutrition is more common in revision spine surgery for septic reasons when compared with aseptic revision surgery. Acute postoperative infection following aseptic revision surgery is also more common in patients with malnutrition. Further study, in the form of prospective trials, will help to increase our understanding of the effects of malnutrition in spine surgery.
回顾性数据库研究。
确定（1）低蛋白血症与体重指数（BMI）之间的关系；（2）营养不良与因感染行脊柱翻修手术之间的关联；（3）无菌性脊柱翻修术后营养不良与感染之间的关联。
尽管有研究表明营养不良会增加脊柱手术后感染的风险，但支持这一假设的证据存在矛盾。
在美国外科医师学会国家外科质量改进计划（ACS-NSQIP）数据库中，确定了 2006 年至 2014 年间行脊柱翻修手术的患者。低蛋白血症（白蛋白＜3.5g/dL）被用作营养不良的替代标志物。采用多变量分析评估低蛋白血症与感染性脊柱翻修手术和无菌性脊柱翻修手术之间的关系。还评估了无菌性脊柱翻修术后 30 天内低蛋白血症与深部感染之间的关系。
共纳入 3136 例行脊柱翻修手术的患者；2922 例（93.2%）因无菌原因手术，214 例（6.8%）因感染原因手术。低蛋白血症存在于所有 BMI 组，包括肥胖患者，尽管在体重不足的患者中发生率最高（22.4%）。因感染原因行手术的患者低蛋白血症发生率高于因无菌原因行手术的患者（49.1% vs. 8.5%，P＜0.001），低蛋白血症的发生风险是后者的 9 倍（校正比值比，OR=9.17，P＜0.001）。在 2922 例行无菌性脊柱翻修手术的患者中，低蛋白血症与术后 30 天内急性深部感染独立相关（校正 OR=2.85，P=0.019）。
与无菌性脊柱翻修手术相比，感染性脊柱翻修手术时营养不良更为常见。无菌性脊柱翻修术后的急性术后感染在营养不良患者中也更为常见。前瞻性试验等进一步研究将有助于加深我们对脊柱手术中营养不良影响的理解。
3 级
