Key result
Preoperative prealbumin ≤ 20 mg/dl was associated with an increased risk of postoperative surgical site infection compared to levels > 20 mg/dl (17.8% vs 4.8%; adjusted OR 3.28, P=0.02).
Why the study?
Does a low preoperative prealbumin level increase the risk of postoperative surgical site infection in patients undergoing elective spine surgery?
Cohort (n=387)
Does a low preoperative prealbumin level increase the risk of postoperative surgical site infection in patients undergoing elective spine surgery?
Odds Ratio: 3.28
Absolute Event Rate: 17.8% vs 4.8%
p-value: p=0.02
Low preoperative prealbumin levels (≤ 20 mg/dl) are significantly associated with an increased risk of surgical site infection following elective spine surgery.
Low prealbumin was associated with higher SSI risk after elective spine surgery; leaves open whether nutritional prehabilitation reduces infections.
OBJECTIVENutritional deficiency negatively affects outcomes in many health conditions. In spine surgery, evidence linking preoperative nutritional deficiency to postoperative surgical site infection (SSI) has been limited to small retrospective studies. Authors of the current study analyzed a large consecutive cohort of patients who had undergone elective spine surgery to determine the relationship between a serum biomarker of nutritional status (preoperative prealbumin levels) and SSI.METHODSThe authors conducted a retrospective review of the electronic medical charts of patients who had undergone posterior spinal surgeries and whose preoperative prealbumin level was available. Additional data pertinent to the risk of SSI were also collected. Patients who developed a postoperative SSI were identified, and risk factors for postoperative SSI were analyzed. Nutritional deficiency was defined as a preoperative serum prealbumin level ≤ 20 mg/dl.RESULTSAmong a consecutive series of 387 patients who met the study criteria for inclusion, the infection rate for those with preoperative prealbumin ≤ 20 mg/dl was 17.8% (13/73), versus 4.8% (15/314) for those with preoperative prealbumin > 20 mg/dl. On univariate and multivariate analysis a low preoperative prealbumin level was a risk factor for postoperative SSI with a crude OR of 4.29 (p < 0.01) and an adjusted OR of 3.28 (p = 0.02). In addition, several previously known risk factors for infection, including diabetes, spinal fusion, and number of operative levels, were significant for the development of an SSI.CONCLUSIONSIn this consecutive series, preoperative prealbumin levels, a serum biomarker of nutritional status, correlated with the risk of SSI in elective spine surgery. Prehabilitation before spine surgery, including strategies to improve nutritional status in patients with nutritional deficiencies, may increase value and improve spine care.
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Salvetti et al. (2018) conducted a cohort in Elective spine surgery (n=387). Preoperative prealbumin level ≤ 20 mg/dl vs. Preoperative prealbumin > 20 mg/dl was evaluated on Postoperative surgical site infection (SSI) (OR 3.28, p=0.02). Preoperative prealbumin ≤ 20 mg/dl was associated with an increased risk of postoperative surgical site infection compared to levels > 20 mg/dl (17.8% vs 4.8%; adjusted OR 3.28, P=0.02).
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