- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15218, USA
David J. Salvetti
Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15218, USA
DOI:10.4103/2152-7806.166893Copyright: © 2015 Salvetti DJ. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
How to cite this article: Salvetti DJ, Tempel ZJ, Gandhoke GS, Parry PV, Grandhi RM, Kanter AS, Okonkwo DO. Preoperative prealbumin level as a risk factor for surgical site infection following elective spine surgery. Surg Neurol Int 08-Oct-2015;6:
How to cite this URL: Salvetti DJ, Tempel ZJ, Gandhoke GS, Parry PV, Grandhi RM, Kanter AS, Okonkwo DO. Preoperative prealbumin level as a risk factor for surgical site infection following elective spine surgery. Surg Neurol Int 08-Oct-2015;6:. Available from: http://surgicalneurologyint.com/surgicalint_articles/preoperative-prealbumin-level-as-a-risk-factor-for-surgical-site/
Background:Nutritional status is a critical factor in patient outcomes in a variety of medical contexts. In the surgical fields, there is substantial evidence suggesting that clinical outcomes including infection risk and surgical efficacy may be affected by preoperative nutritional status. The purpose of this study is to evaluate preoperative serum prealbumin levels, the currently preferred serum biomarker of nutritional deficiency, in relation to the risk of developing a surgical site infection.
Methods:A retrospective case–control series was conducted comparing prospectively collected preadmission serum prealbumin levels to the risk for surgical site infection following elective spine surgery. The analysis was conducted under an approved institutional quality assurance protocol. Patients were identified by querying the department billing codes for deep wound washouts over a 3-year period. A cohort of 32 patients with preoperative prealbumin levels who underwent spine surgery complicated by postoperative deep tissue infection was identified. This was compared against a case–control cohort of 74 patients who underwent spine surgery and did not experience postoperative infection. Clinical variables included demographic information, body mass index, smoking, diabetes, steroid use, length of the procedure, and length of hospital stay. The data were analyzed using multivariate Cox regression.
Results:Two variables: Preoperative prealbumin
Conclusions:Our results reinforce the relationship between preoperative nutritional status and outcomes in elective spine surgery. The data indicate that preoperative prealbumin levels may be useful in risk stratification. Further study is needed to determine whether nutritional supplementation may reduce the risk of infection.
Keywords: Malnutrition, nutrition, prealbumin, spinal fusion, spine surgery
Nutritional status is a critical factor in patient outcomes in a variety of medical contexts.[
A retrospective case–control series was conducted comparing prospectively collected, preadmission, serum prealbumin levels to the risk for surgical site infection following elective spine surgery. The analysis was conducted under an approved institutional quality assurance protocol. In August of 2009, prealbumin was added to the routine preoperative laboratory panel for all patients undergoing elective spine surgery by the two senior authors at Presbyterian Hospital at the University of Pittsburgh Medical Center. A cohort of patients who experienced postoperative wound infections between 2009 and 2012 was identified. The resulting 292 surgical wound washouts performed during this 3-year period were further narrowed to patients with available preoperative prealbumin levels. Patients with a known cancer diagnosis, with traumatic or infectious pathology, or who underwent minimally invasive or anterior approaches to the spine were further excluded. The above process resulted in 32 patients meeting criteria for inclusion. Subsequently, a case–control cohort of 74 patients who did not experience a postoperative wound infection was assembled from a database of all patients who underwent elective open posterior spinal surgery during the same time interval. Patients were selected based on surgical location, age, number of levels operated, and the availability of preoperative prealbumin levels. The electronic medical record for each patient was then reviewed, and additional clinical and demographic data were collected. Statistical analysis was performed by the department statistician using SPSS (IBM, Armonk, NY, USA).
A Chi-squared analysis was used to assess for differences in the basic clinical and demographic parameters found in
The current study demonstrates a link between preoperative nutritional status (low serum prealbumin) and postoperative risk for development of a deep wound infection. We previously reported that decreased prealbumin levels were noted in patients with deep wound infection at the time of re-admission for infection.[
Several prior studies have linked nutritional status to postoperative complications in spine surgery utilizing albumin levels as a surrogate marker.[
The current study has several limitations.First, the study is a retrospective cohort analysis and is, therefore, subject to the limitations inherent to the study design. This is also a single institution analysis that was limited in selecting patients based on the availability of preoperative prealbumin levels. Thus, the patients in this study represent a small segment of those who have undergone spinal fusion at our institution. Further study is needed in this area to prove that nutritional status is a definitively useful tool for risk stratifying patients for postoperative complications. The ultimate goal would be to reduce postoperative infections through preoperative nutritional supplementation. While there have been several small trials of perioperative supplementation with total parenteral nutrition in deformity surgeries with largely negative results, there has been minimal work performed in this regard and represents a potentially inexpensive, noninvasive avenue by which complications may be reduced.[
Prealbumin is a useful marker of nutritional status that predicts patients who are at an increased risk of developing postoperative deep wound infections following spine surgery. This has changed our practice pattern to include further education regarding preoperative nutrition. Ultimately, further study is needed to determine whether the risk of developing an infection may be mitigated by preoperative nutritional supplementation.
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