Departments of1Neurosurgery and.
2Wayne State University School of Medicine, Detroit, Michigan.
J Neurosurg Spine. 2024 Sep 6;41(6):792-802. doi: 10.3171/2024.5.SPINE24113. Print 2024 Dec 1.
Patients with serum albumin levels < 3.5 g/dL are considered malnourished, but there is a paucity of data regarding the outcomes of patients with albumin levels > 3.5 g/dL. The objective of this study was to evaluate the effect of albumin on postoperative outcome in patients undergoing elective cervical and lumbar spine procedures.
The Michigan Spine Surgery Improvement Collaborative database was queried for lumbar and cervical fusion surgeries between January 2020 and December 2022. Patients were grouped by preoperative serum albumin levels: < 3.5 g/dL, 3.5-3.7 g/dL, 3.8-4.0 g/dL, and > 4.0 g/dL. Primary outcomes included urinary retention, ileus, dysphagia, surgical site infection (SSI), readmission within 30 and 90 days, return to the operating room, and length of stay (LOS) ≥ 4 days. Multivariate analysis was conducted to adjust for potential confounders.
This study included 15,629 lumbar cases and 6889 cervical cases. Within the lumbar cohort, an albumin level of 3.5-3.7 g/dL was associated with an increased risk of readmission at 30 days (p = 0.048) and 90 days (p = 0.005) and an LOS ≥ 4 days (p < 0.001). An albumin level of 3.8-4.0 g/dL was associated with an increased risk of an LOS ≥ 4 days (p < 0.001). Within the cervical cohort, an albumin level of 3.5-3.7 g/dL was associated with an increased risk of SSI (p = 0.023), readmission at 30 days (p < 0.002) and 90 days (p < 0.001), return to the operating room (p = 0.002), and an LOS ≥ 4 days (p < 0.001). An albumin level of 3.8-4.0 g/dL was associated with an increased risk of readmission at 30 days (p = 0.012) and 90 days (p = 0.001) and an LOS ≥ 4 days (p < 0.001).
This study maintains that patients with hypoalbunemia undergoing spine surgery are at risk for postoperative adverse events. However, there also exist significant associations between borderline serum albumin levels of 3.5-4.0 g/dL and increased risk of postoperative adverse events.
血清白蛋白水平<3.5g/dL 的患者被认为存在营养不良，但对于白蛋白水平>3.5g/dL 的患者的术后结局数据却很少。本研究的目的是评估白蛋白对择期颈椎和腰椎手术患者术后结局的影响。
对 2020 年 1 月至 2022 年 12 月期间密歇根州脊柱手术改进协作数据库中的腰椎和颈椎融合手术进行了查询。患者根据术前血清白蛋白水平分为以下几组：<3.5g/dL、3.5-3.7g/dL、3.8-4.0g/dL 和>4.0g/dL。主要结局包括尿潴留、肠梗阻、吞咽困难、手术部位感染（SSI）、术后 30 天和 90 天内再入院、重返手术室和住院时间（LOS）≥4 天。采用多变量分析调整潜在混杂因素。
本研究纳入了 15629 例腰椎病例和 6889 例颈椎病例。在腰椎队列中，白蛋白水平为 3.5-3.7g/dL 与术后 30 天（p=0.048）和 90 天（p=0.005）再入院以及 LOS≥4 天（p<0.001）的风险增加相关。白蛋白水平为 3.8-4.0g/dL 与 LOS≥4 天的风险增加相关（p<0.001）。在颈椎队列中，白蛋白水平为 3.5-3.7g/dL 与 SSI（p=0.023）、术后 30 天（p<0.002）和 90 天（p<0.001）再入院、重返手术室（p=0.002）和 LOS≥4 天（p<0.001）的风险增加相关。白蛋白水平为 3.8-4.0g/dL 与术后 30 天（p=0.012）和 90 天（p=0.001）再入院以及 LOS≥4 天的风险增加相关（p<0.001）。
本研究认为接受脊柱手术的低白蛋白血症患者存在术后不良事件的风险。然而，血清白蛋白水平在 3.5-4.0g/dL 之间也存在显著相关性，与术后不良事件风险增加相关。
