Association of Malnutrition with Spine Surgery Outcomes for Odontoid Fractures

Introduction: Malnutrition has been shown to be a predictor of poor surgical outcomes but its specific effects in patients undergoing surgery for odontoid fractures is understudied. This study aims to assess the association between nutritional status and postoperative outcomes, as measured by extended length of stay (LOS), adverse events (AEs), non-routine discharge (NRD), and 30-day mortality.

Methods: We conducted a retrospective cohort study using the 2007-2022 American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database to identify adult patients who underwent spinal surgery for odontoid fractures. The study population was divided into two groups: Nourished (preoperative serum albumin values ≥ 3.5 g/dL) and Malnourished (preoperative serum albumin values < 3.5 g/dL). Multivariable logistic regression analyses were performed to identify factors associated with extended LOS, NRD, AEs, and 30-day mortality.

Results: Among the 481 patients studied, 233 (48.4%) were female, 405 (92.1%) were non-Hispanic White, 340 (70.7%) were classified as Nourished, and 141 (29.3%) as Malnourished. Patients in the Malnourished group had significantly higher proportions of minor (Nourished: 7.4% vs. Malnourished: 16.3, p= 0.003) and severe AEs (Nourished: 12.7% vs. Malnourished: 26.2, p< 0.001). Malnourished patients also had significantly longer average LOS (Nourished: 6.2 ± 4.7 days vs. Malnourished: 10.7 ± 7.2 days, p< 0.001), increased proportion of NRD (Nourished: 37.2% vs. Malnourished: 71.0%, p< 0.001), and higher 30-day mortality (Nourished: 3.5% vs. Malnourished: 9.2%, p=0.010). On multivariate analysis, malnourishment was significantly associated with an increased risk of extended LOS [aOR: 3.47, 95% CI: 2.16-5.58, p< 0.001)], AEs [aOR: 1.85, 95% CI: 1.13-3.03, p=0.014], and NRD [aOR: 2.72, 95% CI: 1.57-4.69, p< 0.001], but was not significantly associated with 30-day mortality.

Conclusion : This study demonstrates a significant association between malnourishment and extended hospital stays, non-routine discharge, and 30-day adverse events in patients undergoing surgery for odontoid fractures. Further research is needed to explore these relationships and develop interventions to mitigate the negative impact of malnourishment on postoperative outcomes.