Elsamadicy Aladine A, Serrato Paul, Ghanekar Shaila D, Mitre Lucas P, Khalid Syed I, Lo Sheng-Fu Larry, Sciubba Daniel M
Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, United States.
Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, United States.
Clin Neurol Neurosurg. 2025 Feb;249:108754. doi: 10.1016/j.clineuro.2025.108754. Epub 2025 Jan 23.
Malnutrition is a predictor of poor surgical outcomes, but its specific effects in spinal epidural abscess (SEA) are understudied. This study aims to assess the association between nutritional status and post-operative outcomes.
We conducted a retrospective cohort study using the 2011-2022 American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database to identify adult SEA patients who underwent spinal surgery. The study population was divided into two groups: Nourished (preoperative serum albumin values ≥ 3.5 g/dL) and Malnourished (preoperative serum albumin values < 3.5 g/dL). Multivariable logistic regression analyses were performed to identify factors associated with extended length of stay (LOS), adverse events (AEs), non-routine discharge (NRD), 30-day unplanned reoperation, and mortality.
1462 patients were identified and stratified by nutrition status: 300 Nourished (20.5 %) and 1162 Malnourished (79.5 %). Patients in the Malnourished cohort had a significantly higher incidence of severe medical AEs (Nourished: 42.7 % vs. Malnourished: 55.9, p < 0.001). The Malnourished cohort also had significantly increased LOS (Nourished: 11.0 ± 7.4 days vs. Malnourished: 16.0 ± 11.8 days, p< 0.001), NRD (Nourished: 50.3 % vs. Malnourished: 72.5%, p < 0.001), 30-day mortality (Nourished: 2.0% vs. Malnourished: 4.8 %, p = 0.031), and 30-day reoperation (Nourished: 9.3 % vs. Malnourished: 16.5 %, p = 0.002). On multivariable analysis, malnourishment was an independent predictor of extended LOS [OR: 2.47 (CI: 1.65-3.71), p< 0.001], AEs [OR: 1.41 (CI: 1.08-1.83), p = 0.011], and NRD [OR: 1.93 (CI: 1.44-2.58), p < 0.001], but not 30-day unplanned reoperation or mortality.
Our study suggests that malnourishment may be associated with worse post-surgical outcomes for SEA patients.
营养不良是手术预后不良的一个预测指标，但它在脊柱硬膜外脓肿（SEA）中的具体影响尚未得到充分研究。本研究旨在评估营养状况与术后预后之间的关联。
我们进行了一项回顾性队列研究，使用2011 - 2022年美国外科医师学会（ACS）国家外科质量改进计划（NSQIP）数据库来识别接受脊柱手术的成年SEA患者。研究人群分为两组：营养良好组（术前血清白蛋白值≥3.5 g/dL）和营养不良组（术前血清白蛋白值<3.5 g/dL）。进行多变量逻辑回归分析以确定与住院时间延长（LOS）、不良事件（AE）、非常规出院（NRD）、30天非计划再次手术和死亡率相关的因素。
共识别出1462例患者，并根据营养状况进行分层：300例营养良好（20.5%）和1162例营养不良（79.5%）。营养不良队列中的患者发生严重医疗不良事件的发生率显著更高（营养良好组：42.7% vs. 营养不良组：55.9%，p<0.001）。营养不良队列的住院时间也显著延长（营养良好组：11.0±7.4天 vs. 营养不良组：16.0±11.8天，p<0.001），非常规出院率更高（营养良好组：50.3% vs. 营养不良组：72.5%，p<0.001），30天死亡率更高（营养良好组：2.0% vs. 营养不良组：4.8%，p = 0.031），30天再次手术率更高（营养良好组：9.3% vs. 营养不良组：16.5%，p = 0.002）。多变量分析显示，营养不良是住院时间延长[比值比（OR）：2.47（置信区间（CI）：1.65 - 3.71），p<0.001]、不良事件[OR：1.41（CI：1.08 - 1.83），p = 0.011]和非常规出院[OR：1.93（CI：1.44 - 2.58），p<0.001]的独立预测因素，但不是30天非计划再次手术或死亡率的独立预测因素。
我们的研究表明，营养不良可能与SEA患者术后预后较差有关。
