Klein J D, Hey L A, Yu C S, Klein B B, Coufal F J, Young E P, Marshall L F, Garfin S R
Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York, USA.
Spine (Phila Pa 1976). 1996 Nov 15;21(22):2676-82. doi: 10.1097/00007632-199611150-00018.
The authors undertook a three-part study to better understand the impact of perioperative nutritional status on postoperative complications in patients undergoing spinal surgery. In preliminary Parts I and II, the authors targeted two groups of patients who are particularly nutritionally challenged. In Part III, they studied a large group of consecutive patients undergoing routine lumbar spinal fusion.
To determine whether preoperative nutritional status was a significant predictor of postoperative complications in patients undergoing elective lumbar spinal fusion.
In Part I, 27 patients treated surgically for vertebral osteomyelitis were divided into two groups based on their preoperative nutritional status. Twenty-four of the 26 postoperative complications were in the malnourished group (P < 0.001). In Part II, 15 (75%) of 20 patients treated surgically for spinal cord injury were found to become malnourished in the postoperative period. Seventeen complications were noted, all in the malnourished group (P = 0.001).
One hundred fourteen consecutive patients undergoing selective lumbar decompression and fusion were identified and their records reviewed. In addition to preoperative nutritional status, data gathered included age, sex, height, weight, past medical history, steroid use, alcohol use, tobacco use, type of bone graft (allograft vs. autograft), history of previous lumbar surgery, number of levels fused, and use of spinal instrumentation.
Eleven of 13 postoperative infectious complications (10 deep wound infections) were noted in the malnourished group (P < 0.001). By stepwise logistic regression analysis, preoperative nutritional status was an extremely significant independent predictor of postoperative complications in patients undergoing elective lumbar spinal fusion (P = 0.0018).
The prevalence data in our study population suggest that a large number (25%) of patients undergoing elective lumbar spine surgery are nourished inadequately at surgery. This number is higher (42%) in older patients. The authors recommend that close attention be paid to the perioperative nutritional status of patients undergoing lumbar spinal surgery. Patients with suboptimal nutritional parameters should be supplemented and replenished before elective surgery.
作者开展了一项分为三个部分的研究，以更好地了解围手术期营养状况对接受脊柱手术患者术后并发症的影响。在初步的第一部分和第二部分中，作者针对两组营养状况特别差的患者。在第三部分中，他们研究了一大组连续接受常规腰椎融合手术的患者。
确定术前营养状况是否是接受择期腰椎融合手术患者术后并发症的重要预测因素。
在第一部分中，27例接受手术治疗的椎体骨髓炎患者根据术前营养状况分为两组。26例术后并发症中的24例发生在营养不良组（P < 0.001）。在第二部分中，20例接受手术治疗的脊髓损伤患者中有15例（75%）在术后出现营养不良。共记录到17例并发症，均发生在营养不良组（P = 0.001）。
确定了114例连续接受选择性腰椎减压融合手术的患者，并对其记录进行回顾。除术前营养状况外，收集的数据还包括年龄、性别、身高、体重、既往病史、类固醇使用情况、饮酒情况、吸烟情况、骨移植类型（同种异体移植与自体移植）、既往腰椎手术史、融合节段数以及脊柱内固定器械的使用情况。
13例术后感染性并发症中的11例（10例深部伤口感染）发生在营养不良组（P < 0.001）。通过逐步逻辑回归分析，术前营养状况是接受择期腰椎融合手术患者术后并发症的极其重要的独立预测因素（P = 0.0018）。
我们研究人群中的患病率数据表明，大量（25%）接受择期腰椎手术的患者在手术时营养不足。老年患者中这一比例更高（42%）。作者建议密切关注接受腰椎手术患者的围手术期营养状况。营养参数欠佳的患者应在择期手术前进行补充和营养恢复。
