Serrato Paul, Craft Samuel, Sayeed Sumaiya, Hengartner Astrid C, Belkasim Selma, Sadeghzadeh Sina, DiLuna Michael L, Elsamadicy Aladine A
1Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut; and.
2Department of Neurosurgery, Stanford University School of Medicine, Stanford, California.
J Neurosurg. 2024 Nov 15;142(4):1035-1045. doi: 10.3171/2024.7.JNS24875. Print 2025 Apr 1.
Nutritional status has been shown to impact patient outcomes across several neurosurgical procedures. However, few prior studies have assessed associations between preoperative nutritional status and outcomes in elderly patients undergoing subdural hematoma evacuations. The aim of this study was to identify associations between preoperative nutritional status and short-term outcomes in patients aged 65 years and older undergoing subdural hematoma evacuation.
A retrospective cohort study was performed using the American College of Surgeons National Surgical Quality Improvement Program database. Geriatric patients (≥ 65 years of age) were categorized into three groups based on the Geriatric Nutritional Risk Index (GNRI): normal, malnourished, and severely malnourished. Patient demographic characteristics, comorbidities, and adverse events (AEs) were assessed. Multivariate logistic regression analyses were used to identify independent predictors of 30-day postoperative AEs, extended length of hospital stay (LOS), 30-day mortality, and nonroutine discharge.
Of 2026 study patients, 908 (44.8%) had normal GNRI status, 564 (27.8%) had malnourished GNRI status, and 554 (27.3%) had severely malnourished GNRI status. The proportions of patients who experienced minor AEs (normal 12.7% vs malnourished 13.3% vs severely malnourished 19.0%, p = 0.003) and severe AEs (normal 25.3% vs malnourished 20.7% vs severely malnourished 35.7%, p ≤ 0.001) were greatest in the severely malnourished cohort. Mean LOS significantly increased along with increasing malnourishment (normal 9.1 ± 6.9 days vs malnourished 9.7 ± 7.0 days vs severely malnourished 11.3 ± 7.6 days, p ≤ 0.001), whereas the proportions of patients with 30-day mortality (normal 15.5% vs malnourished 15.6% vs severely malnourished 24.0%, p ≤ 0.001) and nonroutine discharge (normal 59.4% vs malnourished 66.1% vs severely malnourished 69.9%, p ≤ 0.001) similarly increased with increasing malnourishment. On multivariate analyses, severe malnourished status was significantly associated with increased odds of developing any AE (adjusted OR [aOR] 1.72, CI 1.33-2.23, p ≤ 0.001) and extended LOS (aOR 1.47, CI 1.11-1.95, p = 0.007), whereas malnourished status but not severely malnourished status was associated with increased odds of nonroutine discharge (aOR 1.46, CI 1.12-1.92, p = 0.006). Neither malnourished (p = 0.474) nor severely malnourished status (p = 0.367) was associated with increased odds of 30-day mortality.
The authors' findings suggest that preoperative nutritional status may have implications for short-term outcomes after subdural hematoma evacuation in patients aged 65 years and older. Further studies are necessary to better optimize nutritional status perioperatively in this patient population.
营养状况已被证明会影响多种神经外科手术患者的预后。然而，此前很少有研究评估老年患者硬膜下血肿清除术前营养状况与预后之间的关联。本研究的目的是确定65岁及以上接受硬膜下血肿清除术患者术前营养状况与短期预后之间的关联。
使用美国外科医师学会国家外科质量改进计划数据库进行一项回顾性队列研究。老年患者（≥65岁）根据老年营养风险指数（GNRI）分为三组：正常、营养不良和严重营养不良。评估患者的人口统计学特征、合并症和不良事件（AE）。采用多因素逻辑回归分析确定术后30天AE、延长住院时间（LOS）、30天死亡率和非常规出院的独立预测因素。
在2026例研究患者中，908例（44.8%）GNRI状态正常，564例（27.8%）GNRI状态营养不良，554例（27.3%）GNRI状态严重营养不良。发生轻度AE的患者比例（正常组12.7% vs 营养不良组13.3% vs 严重营养不良组19.0%，p = 0.003）和重度AE的患者比例（正常组25.3% vs 营养不良组20.7% vs 严重营养不良组35.7%，p≤0.001）在严重营养不良队列中最高。平均住院时间随着营养不良程度的增加而显著延长（正常组9.1±6.9天 vs 营养不良组9.7±7.0天 vs 严重营养不良组11.3±7.6天，p≤0.001），而30天死亡率（正常组15.5% vs 营养不良组15.6% vs 严重营养不良组24.0%，p≤0.001）和非常规出院的患者比例（正常组59.4% vs 营养不良组66.1% vs 严重营养不良组69.9%，p≤0.001）也随着营养不良程度的增加而类似地增加。多因素分析显示，严重营养不良状态与发生任何AE的几率增加（调整后OR[aOR]1.72，CI 1.33 - 2.23，p≤0.001）和延长住院时间（aOR 1.47，CI 1.11 - 1.95，p = 0.007）显著相关，而营养不良状态（而非严重营养不良状态）与非常规出院几率增加相关（aOR 1.46，CI 1.12 - 1.92，p = 0.006）。营养不良（p = 0.474）和严重营养不良状态（p = 0.367）均与30天死亡率增加无关。
作者的研究结果表明，术前营养状况可能对65岁及以上患者硬膜下血肿清除术后的短期预后有影响。有必要进一步研究以更好地优化该患者群体围手术期的营养状况。
