Prehab the Labs: Predicting Surgical Outcomes in Spine Fractures Through Preoperative Lab Values

Study Design Retrospective Cohort Study. Objectives To evaluate the prognostic utility of preoperative laboratory values (PLVs) in predicting 30-day postoperative outcomes among patients undergoing single-level vertebral fracture fixation. Methods The ACS-NSQIP database (2015-2020) was queried to identify adults who underwent single-level vertebral fracture fusion. Patients were stratified by PLV categories using clinically relevant hypo- and hyper-thresholds. Outcomes included 30-day mortality, major complications, Clavien-Dindo IV complications, non-home discharge (NHD), readmission, reoperation, and extended length of stay. Multivariate logistic regression adjusted for demographics and comorbidities was used to assess associations between PLVs and adverse outcomes. Results A total of 4005 patients were identified. Hypoalbuminemia emerged as the strongest independent predictor of poor outcomes, including mortality (OR 4.05, 95% CI 2.14-7.69, P < 0.001), major complications (OR 1.94, 95% CI 1.46-2.57, P < 0.01), and NHD (OR 1.72, 95% CI 1.37-2.17, P < 0.001). Elevated creatinine and leukocytosis were significantly associated with increased mortality ( P = 0.047) and Clavien-Dindo IV complications ( P < 0.001), while preoperative anemia predicted prolonged hospitalization ( P < 0.01). Conclusions Among patients undergoing single-level vertebral fixation for fracture, hypoalbuminemia is the most consistent predictor of adverse 30-day outcomes. Elevated creatinine, leukocytosis, and anemia also confer independent risks for specific complications. Incorporating PLVs into preoperative risk stratification may enhance patient counseling, optimize perioperative planning, and identify candidates for targeted prehabilitation.