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Abstract：
Background: Malnutrition is a common condition that may exacerbate many medical and surgical pathologies. However, few have studied the impact of malnutrition on surgical outcomes for patients undergoing surgery for metastatic disease of the spine. This study aims to evaluate the impact of malnutrition on perioperative complications and healthcare resource utilization following surgical treatment of spinal metastases. Methods: We conducted a retrospective cohort study using the 2011-2019 American College of Surgeons National Surgical Quality Improvement Program database. Adult patients with spinal metastases who underwent laminectomy, corpectomy, or posterior fusion for extradural spinal metastases were identified using the CPT, ICD-9-CM, and ICD-10-CM codes. The study population was divided into two cohorts: Nourished (preoperative serum albumin values ≥ 3.5 g/dL) and Malnourished (preoperative serum albumin values < 3.5 g/dL). We assessed patient demographics, comorbidities, intraoperative variables, postoperative adverse events (AEs), hospital LOS, discharge disposition, readmission, and reoperation. Multivariate logistic regression analyses were performed to identify the factors associated with a prolonged length of stay (LOS), AEs, non-routine discharge (NRD), and unplanned readmission. Results: Of the 1613 patients identified, 26.0% were Malnourished. Compared to Nourished patients, Malnourished patients were significantly more likely to be African American and have a lower BMI, but the age and sex were similar between the cohorts. The baseline comorbidity burden was significantly higher in the Malnourished cohort compared to the Nourished cohort. Compared to Nourished patients, Malnourished patients experienced significantly higher rates of one or more AEs (Nourished: 19.8% vs. Malnourished: 27.6%, p = 0.004) and serious AEs (Nourished: 15.2% vs. Malnourished: 22.6%, p < 0.001). Upon multivariate regression analysis, malnutrition was found to be an independent and associated with an extended LOS [aRR: 3.49, CI (1.97, 5.02), p < 0.001], NRD [saturated aOR: 1.76, CI (1.34, 2.32), p < 0.001], and unplanned readmission [saturated aOR: 1.42, CI (1.04, 1.95), p = 0.028]. Conclusions: Our study suggests that malnutrition increases the risk of postoperative complication, prolonged hospitalizations, non-routine discharges, and unplanned hospital readmissions. Further studies are necessary to identify the protocols that pre- and postoperatively optimize malnourished patients undergoing spinal surgery for metastatic spinal disease.
摘要：
背景：营养不良是一种常见疾病，可能会加剧许多内科和外科疾病。然而,很少有人研究营养不良对脊柱转移性疾病手术患者手术结局的影响.这项研究旨在评估营养不良对脊柱转移瘤手术治疗后围手术期并发症和医疗资源利用的影响。方法：我们使用2011-2019年美国外科医生协会国家外科质量改善计划数据库进行了一项回顾性队列研究。接受椎板切除术的成年脊柱转移患者，全身切除术,或使用CPT确定硬膜外脊柱转移瘤的后路融合，ICD-9-CM,和ICD-10-CM代码。研究人群分为两组：营养（术前血清白蛋白值≥3.5g/dL）和营养不良（术前血清白蛋白值<3.5g/dL）。我们评估了患者的人口统计学，合并症,术中变量，术后不良事件（AE），医院LOS,放电处理,重新接纳,再操作。进行多变量逻辑回归分析以确定与住院时间延长（LOS）相关的因素。AEs,非常规放电(NRD),和计划外的重新接纳。结果：在确认的1613例患者中，26.0%营养不良。与滋养患者相比，营养不良患者更有可能是非裔美国人，并且BMI较低，但是两组的年龄和性别相似。与营养队列相比，营养不良队列的基线合并症负担明显更高。与滋养患者相比，营养不良患者出现一种或多种不良事件的比率明显较高(营养：19.8%与营养不良：27.6%，p=0.004）和严重的不良事件（营养：15.2%与营养不良：22.6%，p<0.001)。经多元回归分析，发现营养不良是独立的，并与延长的LOS相关[ARR：3.49，CI(1.97，5.02)，p<0.001],NRD[饱和AOR：1.76，CI（1.34，2.32），p<0.001],和计划外再入院[饱和AOR：1.42，CI（1.04，1.95），p=0.028]。结论：我们的研究表明，营养不良会增加术后并发症的风险，长期住院,非常规放电，和计划外的医院再入院。需要进一步的研究来确定术前和术后优化营养不良的患者接受脊柱手术治疗转移性脊柱疾病的方案。
