Assessing Utilization Patterns of Preoperative Nutritional Consultation in Transforaminal Lumbar Interbody Fusion (TLIF) Patients: A Descriptive Analysis

Introduction: Perioperative malnutrition is a common concern among patients undergoing spinal procedures, including Transforaminal Lumbar Interbody Fusion (TLIF), where it is linked to adverse outcomes and prolonged hospitalization. Optimizing nutritional status preoperatively presents a promising opportunity to enhance recovery trajectories and mitigate healthcare costs. While postoperative nutritional supplementation has been explored, the utilization and impact of targeted preoperative nutritional consultation (NC) remains underdefined, particularly in the TLIF population. This study aims to characterize the demographic profile and delineate preoperative NC utilization patterns for TLIF patients.

Methods: This retrospective cohort study utilized the Pearl Diver National Insurance Claims Database to identify adult patients from 2010 to 2023 who underwent TLIF surgery. Patients were stratified by receipt of preoperative nutritional consultation (NC) and further categorized by the number of surgical segments ( < 6 vs. >6). NC utilization was evaluated based on age, gender, region, insurance payor status, service location, and length of stay.

Results: Among 1,070,127 TLIF patients, 16,419 (1.5%) received preoperative nutritional consultation (NC). There were 10,223 (62%) female and 6,196 (38%) male patients with a mean age of 57.7 years. Regional analysis indicated higher NC utilization in the Midwestern region of the United States (35.5%) compared to the Southern region (26%), for patients with commercial insurance plans (64.5%) and in the inpatient setting (48.5%). From 2010 to 2023, NC utilization decreased, with a notable shift observed in 2016. Mean length of stay was 3.45 days. NC utilization did not vary significantly by insurance type.

Conclusion : This study is the first to report on epidemiologic patterns surrounding preoperative nutritional consultation (NC) utilization in TLIF patients. The decline in NC utilization likely reflects changes in insurance policy or guidelines. Further research is necessary to ascertain causality between NC and surgical outcomes as results may underscore nutritional status as a potentially modifiable factor and may inform the development of standardized preoperative nutritional protocols in spinal surgery.