Orthopaedic Surgery, Spine Care Institute, Hospital for Special Surgery, New York, New York, USA.
Orthopaedic Surgery, Spine Care Institute, Hospital for Special Surgery, New York, New York, USA; Department of Orthopaedic Surgery, School of Medicine, Showa University Hospital, Tokyo, Japan.
World Neurosurg. 2023 Jun;174:e152-e158. doi: 10.1016/j.wneu.2023.03.095. Epub 2023 Mar 25.
Frailty status and hypoalbuminemia have been associated with higher rates of complications after spine surgery. However, the combination of both conditions has not been fully analyzed. The objective of this study was to assess the effect of frailty and hypoalbuminemia on the risk of complications after spine surgery.
The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database from 2009 to 2019 was used. Frailty status was calculated using the modified 5-item frailty index (mFI-5). Patients were classified into nonfrail (mFI = 0), pre-frail (mFI = 1), and frail (mFI ≥2) groups and also based on albumin levels into normal (≥3.5 g/dL) and hypoalbuminemia groups (<3.5 g/dL). The latter group was also subclassified into mild and severe hypoalbuminemia groups. Multivariable analysis was used. A Spearman ρ correlation between albuminemia and mFI-5 was also performed.
A total of 69,519 patients (36,705 men [52.8%] and 32,814 women [47.2%]) with a mean age of 61.0 ± 13.2 years were included. Patients were classified as nonfrail (n = 24,897), pre-frail (n = 28,897), and frail groups (n = 15,725). Hypoalbuminemia was significantly higher in the frail group (11.4%) compared with the nonfrail group (4.3%). An inverse correlation was observed between albumin levels and frailty status (ρ = -0.139; P < 0.0001). Frail patients with severe hypoalbuminemia had significantly higher risk of complications (odds ratio [OR], 5.0), reoperation (OR, 3.3), readmission (OR, 3.1), and mortality (OR, 31.8) compared with patients without hypoalbuminemia.
The combination of frailty and hypoalbuminemia significantly increases the risk of complications after spine surgery. The prevalence of hypoalbuminemia in the frailty group was significantly higher than in nonfrail patients (11.4% vs. 4.3%). Both conditions should be evaluated preoperatively.
虚弱状态和低白蛋白血症与脊柱手术后并发症发生率较高有关。然而，这两种情况的结合尚未得到充分分析。本研究的目的是评估虚弱和低白蛋白血症对脊柱手术后并发症风险的影响。
使用美国外科医师学会国家外科质量改进计划（ACS-NSQIP）数据库，时间范围为 2009 年至 2019 年。使用改良的 5 项虚弱指数（mFI-5）计算虚弱状态。患者分为非虚弱（mFI=0）、虚弱前期（mFI=1）和虚弱（mFI≥2）组，并根据白蛋白水平分为正常（≥3.5g/dL）和低白蛋白血症组（<3.5g/dL）。后者组也分为轻度和重度低白蛋白血症组。使用多变量分析。还进行了白蛋白血症和 mFI-5 之间的 Spearman ρ 相关性分析。
共纳入 69519 例患者（36705 例男性[52.8%]和 32814 例女性[47.2%]），平均年龄为 61.0±13.2 岁。患者分为非虚弱组（n=24897）、虚弱前期组（n=28897）和虚弱组（n=15725）。与非虚弱组（4.3%）相比，虚弱组的低白蛋白血症明显更高（11.4%）。白蛋白水平与虚弱状态之间存在负相关（ρ=-0.139；P<0.0001）。严重低白蛋白血症的虚弱患者与无低白蛋白血症的患者相比，并发症（比值比[OR]，5.0）、再次手术（OR，3.3）、再入院（OR，3.1）和死亡率（OR，31.8）的风险显著增加。
虚弱和低白蛋白血症的结合显著增加了脊柱手术后并发症的风险。虚弱组的低白蛋白血症患病率明显高于非虚弱患者（11.4%比 4.3%）。这两种情况都应该在术前进行评估。
