Clinical Neurosciences Center, University of Utah Health, Salt Lake City, Utah, USA.
Department of Orthopedics, University of Louisville, Pediatric Orthopedics, Norton Children's Hospital, Norton Leatherman Spine Center, Louisville, Kentucky, USA.
Neurosurgery. 2021 Oct 13;89(Suppl 1):S26-S32. doi: 10.1093/neuros/nyab318.
Preoperative malnutrition has been implicated in adverse events after elective surgery, potentially impacting patient outcomes.
As a potentially modifiable risk factor, we sought to determine which assessments of nutritional status were associated with specific adverse events after spine surgery. In addition, we explored if a preoperative nutritional improvement intervention may be beneficial in lowering the rates of these adverse events.
The literature search yielded 115 abstracts relevant to the PICO (patient/population, intervention, comparison, and outcomes) questions included in this chapter. The task force selected 105 articles for full text review, and 13 met criteria for inclusion in this systematic review.
Malnutrition, assessed preoperatively by a serum albumin <3.5 g/dL or a serum prealbumin <20 mg/dL, is associated with a higher rate of surgical site infections (SSIs), other wound complications, nonunions, hospital readmissions, and other medical complications after spine surgery. A multimodal nutrition management protocol decreases albumin and electrolyte deficiencies in patients with normal preoperative nutritional status. It also improves overall complication rates but does not specifically impact SSIs.
It is recommended to assess nutritional status using either serum albumin or prealbumin preoperatively in patients undergoing spine surgery.The full guidelines can be accessed at https://www.cns.org/guidelines/browse-guidelines-detail/4-preoperative-nutritional-assessment.
术前营养不良与择期手术后的不良事件有关，可能会影响患者的预后。
作为一个潜在可改变的危险因素，我们试图确定哪些营养状况评估与脊柱手术后的特定不良事件相关。此外，我们还探讨了术前营养改善干预是否可能有助于降低这些不良事件的发生率。
文献检索产生了 115 篇与本章中的 PICO（患者/人群、干预、比较和结局）问题相关的摘要。专家组选择了 105 篇文章进行全文审查，其中 13 篇符合纳入本系统评价的标准。
术前通过血清白蛋白<3.5 g/dL 或血清前白蛋白<20 mg/dL 评估的营养不良与脊柱手术后手术部位感染（SSI）、其他伤口并发症、不愈合、医院再入院和其他医疗并发症的发生率较高相关。多模式营养管理方案可减少术前营养状况正常患者的白蛋白和电解质缺乏。它还可以降低总体并发症发生率，但不会对 SSI 产生具体影响。
建议在接受脊柱手术的患者中术前使用血清白蛋白或前白蛋白评估营养状况。完整的指南可在 https://www.cns.org/guidelines/browse-guidelines-detail/4-preoperative-nutritional-assessment 上获取。
