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Preoperative Serum Albumin Level as a Predictor of Postoperative Complication After Spine Fusion

Adogwa, Owoicho MD, MPH*; Martin, Joel R. MS*; Huang, Kevin BA*; Verla, Terence MPH*; Fatemi, Parastou BS*; Thompson, Paul MS*; Cheng, Joseph MD, MS; Kuchibhatla, Maragatha PhD; Lad, Shivanand P. MD, PhD*; Bagley, Carlos A. MD*; Gottfried, Oren N. MD*

doi: 10.1097/BRS.0000000000000450

Study Design. Retrospective cohort study.

Objective. To investigate the association between preoperative baseline serum albumin and postoperative surgical complication.

Summary of Background Data. The prevalence of malnutrition in the hospitalized patient population has only been recently recognized. Preoperative hypoalbuminemia (serum albumin <3.5 g/dL) has been shown to be associated with increased morbidity and mortality rates. The prognostic implications and significance of hypoalbuminemia after spine fusion surgery remain unknown. In this study, we assess the predictive value of preoperative nutritional status (serum albumin level) on postoperative complication rates.

Methods. The medical records of 136 consecutive patients undergoing spine fusion at Duke University Medical Center were reviewed. Preoperative serum albumin level was assessed on all patients and used to quantify nutritional status. Albumin less than 3.5 g/dL was recognized as hypoalbuminemia (malnourished). Patient demographics, comorbidities, and postoperative complication rates were collected. Patients were also stratified into 2 groups based on their cause, namely elective degenerative/deformity versus nonelective cases. The association between preoperative serum albumin level and postoperative complication was assessed via logistic regression analysis.

Results. Overall, 40 (29.4%) patients experience at least 1 postoperative complication. Patients undergoing elective surgery had more complications based on preoperative albumin levels (malnourished patients: 35.7% vs. nourished patients: 11.7%, P = 0.03), whereas those undergoing nonelective surgery had similar complication rates (malnourished patients: 46.5% vs. nourished patients: 42.1%, P = 0.75). For patients undergoing elective spinal surgery, logistic regression with and without propensity score adjustment for risk factors, demonstrated that preoperative serum albumin level was a significant predictor of postoperative complications (OR: 4.21; 95% CI: 1.09–16.19; P = 0.04) and (OR: 4.54; 95% CI: 1.17–19.32; P = 0.04), respectively.

Conclusion. Preoperative hypoalbuminemia is an independent risk factor for postoperative complications after elective spine surgery for degenerative and deformity causes, and should be used more frequently as a prognostic tool to detect malnutrition and risk of adverse surgical outcomes.

Level of Evidence: 2

Consecutive adult spinal fusion cases at our institution were reviewed. Preoperative hypoalbuminemia (serum albumin <3.5 g/dL) was shown to be an independent risk factor (P < 0.05) for postoperative complications after elective spine surgery for degenerative and deformity causes. Both groups within each cohort had similar baseline and operative characteristics.

*Division of Neurosurgery, Department of Surgery, Duke University Medical Center, Durham, NC

Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, TN; and

Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC.

Address correspondence and reprint requests to Oren N. Gottfried, MD, Division of Neurosurgery, Department of Surgery, Duke University Medical Center, Box 4528, Durham, NC 27701; E-mail:

Acknowledgment date: January 22, 2014. Revision date: May 5, 2014. Acceptance date: May 21, 2014.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work.

No relevant financial activities outside the submitted work.

© 2014 by Lippincott Williams & Wilkins