Prevalence and Impact of Malnutrition on Postoperative Outcomes in Patients Undergoing Posterior Cervical Spinal Instrumentation

Introduction: Hypoalbuminemia, defined as serum albumin levels below 3.5 g/dL, is commonly recognized as a marker of malnutrition and has been associated with an increased risk of postoperative complications. However, research examining the impact of malnutrition on these complications following posterior cervical spine surgery remains limited.

Methods: The TriNetX Research Network was queried to identify adult patients who underwent posterior spinal instrumentation surgery with preoperative diagnoses of cervical spinal stenosis, myelopathy, disc disorder, radiculopathy, spondylosis, or spondylolisthesis and who had a preoperative albumin level measured within 30 days before surgery. The study cohort was divided into two groups based on preoperative serum albumin levels: one with levels below 3.5 g/dL and the other with levels of 3.5 g/dL or higher. Propensity score matching was employed to adjust for age, gender, race, and comorbidities. Postoperative occurrences of wound dehiscence (WD), surgical site infection (SSI), and the need for reoperation were identified using corresponding procedural and diagnostic codes within 90 days of the index surgery.

Results: A total of 7,607 patients met the initial inclusion criteria with 1,790 (23.5%) presenting with an albumin level below 3.5 g/dL within 30 days prior to surgery. Propensity score matching resulted in cohorts of 1,785 patients each, with no significant differences in baseline demographics or comorbidities. Post-matching analysis indicated that malnourished patients had significantly higher odds of developing SSI or WD (OR = 1.377, 95% CI: 1.016–1.866) and undergoing reoperation (OR = 1.380, 95% CI: 1.111–1.716) within 90 days postoperatively compared to patients with adequate nutritional status.

Conclusion : This large-scale retrospective study, using propensity score matching, indicates that malnutrition, identified by hypoalbuminemia ( < 3.5 g/dL), is present in 23.5% of adults undergoing posterior cervical spinal instrumentation. Malnourished patients were found to have approximately 40% higher odds of postoperative complications—specifically surgical site infections (SSI), wound dehiscence, and the need for reoperation within 90 days—compared to patients with adequate nutritional status. These findings highlight the potential value of assessing preoperative nutritional status prior to spinal surgery.