Perioperative Serum Prealbumin as a Predictor Of Mortality In Trauma Patients Undergoing Posterior Cervical Decompression and Fusion

Introduction: Posterior cervical decompression and fusion (PCDF) is frequently used to manage cervical spine trauma. Prealbumin, also known as transthyretin, has been widely studied as a marker for assessing nutritional status in the acute setting. In this manuscript, we explore the relationship between prealbumin and mortality in trauma patients undergoing PCDF.

Methods: A retrospective review of PCDF patients from 2011-2022 at two quaternary level one trauma centers was conducted. Demographics, clinical characteristics, surgical details, comorbidities, and radiographic findings were collected. Clinical presentations and follow-up data including in-hospital and long-term mortality, hospital length of stay (LOS), and discharge disposition were collected. Patients were grouped by perioperative prealbumin levels: ≤ 20 mg/dL and > 20 mg/dL.

Results: 591 patients underwent PCDF from 2011-2022. 92 were in the setting of trauma at admission. Baseline characteristics, indications for surgery, and outcomes were similar between groups. Overall, a significant association between prealbumin levels and LOS (p < 0.05) with a curvilinear relationship was observed, suggesting a potential threshold effect. Perioperative prealbumin ≤ 20 mg/dL was significantly associated with longer hospital stays (p=0.0397) but not in patients with prealbumin > 20 mg/dL (p>0.05). No significant associations were found between hospital stay length and age, sex, surgery duration, or fusion level count (p>0.05). Kaplan-Meier analysis showed a significant difference in mortality based on prealbumin levels, with significantly lower survival probabilities in patients with prealbumin ≤ 20 mg/dL (p=0.0402). Pre-albumin independently and significantly predicted days to postoperative mortality in a linear manner (p < 0.01).

Conclusion : Perioperative prealbumin levels ≤ 20 mg/dL are significantly associated with lower survival probabilities and longer hospital stays in spine trauma patients undergoing PCDF. These findings underscore the importance of prealbumin as a prognostic marker, advocating for its inclusion in nutritional assessments to improve outcomes in traumatic cervical spine injury.