Medical Student Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA Pittsburgh, PA, US
Introduction: Posterior Cervical Decompression and Fusion (PCDF) is an effective approach to treating multi-level spinal pathologies. Low prealbumin, an acute phase marker of nutritional status, has been tied to increased rates of surgical site infection in elective spine surgery. However, the relationship of prealbumin with long-term postoperative mortality in patients undergoing PCDF remains understudied.
Methods: Patients undergoing PCDF at two quaternary level one trauma centers from 2011-2022 were retrospectively followed. Demographics, perioperative measures, surgical parameters, and postoperative outcomes were collected. Student’s t-tests, Wilcoxon Rank Sum tests, Chi-squared analyses or Fisher’s exact tests were carried out for univariate comparisons and variable selection (α=0.01) for Cox proportional hazards regression. Kaplan Meier curves were generated to assess survival differences in nutritionally deficient (prealbumin<=20 mg/dl or albumin <=3.4 g/dl) and adequate (prealbumin>20 mg/dl or albumin >3.4 g/dl) patients. Linear regression elucidated concentration dependent relationships of prealbumin/albumin with mortality and LOS.
Results: Of the 590 patients undergoing PCDF from 2011-2022, 302 had perioperative prealbumin and postoperative follow-up data. Multivariate cox regression of survival showed statistical significance for prealbumin (HR: 0.82, p=0.001), frailty score (HR: 1.13, p=0.002), spinal cord injury (HR: 14.67, p=0.002), fracture (HR: 11.83, p=0.003) and discharge to skilled nursing facility (HR: 14.75, p=0.015). Patients with prealbumin >20 mg/dl showed significantly greater long-term survival than those with levels <=20 mg/dl (log-rank p=0.01). In those with prealbumin <=20 mg/dl, there were dose dependent relationships between serum prealbumin concentration and mortality (R2=0.205, p=0.012) and LOS (R2=0.058, p=0.0019). In patients with perioperative albumin >3.4 g/dl, there was a similar correlation between serum albumin and LOS (R2=0.03, p=0.0054).
Conclusion : Serum prealbumin, especially in patients considered nutritionally deficient (<=20 mg/dl), may serve as a prognostic marker for long-term mortality and LOS following PCDF. Future work should assess the predictive power of preoperative levels and characterize these relationships in patients undergoing diverse spinal surgeries.
.jpg)
