Nutritional and Metabolic Factors in Postoperative Outcomes After Spinal Fusion Surgery: A Literature Review

Introduction: Spine surgery recovery outcomes are complex and influenced by a range of physiological and lifestyle factors. Identifying reliable predictors of recovery can inform preoperative evaluations and postoperative care strategies. This literature review synthesizes current research on predictive biomarkers and lifestyle factors related to postoperative recovery. Insight into these will provide a useful clinical guide for surgeons to risk stratify and help create more robust postoperative plans.

Methods: We conducted a systematic review of studies published over the past ten years, focusing on predictors of recovery following spine surgery. Databases including PubMed, MEDLINE, and Cochrane Library were searched using keywords such as “spine surgery recovery,” “NLR,” “transthyretin,” “Hemoglobin A1c,” “albumin,” “prealbumin,” “BMI,” and “exercise.” Studies were included based on predetermined criteria, encompassing both observational and controlled trials that assessed these predictors in adult patients.

Results: Analysis across studies showed that elevated neutrophil-to-lymphocyte ratio (NLR) and Hemoglobin A1c were consistently associated with delayed recovery and poorer outcomes. Markers of nutritional status, including serum albumin and prealbumin, also demonstrated significant correlations with recovery time and complication rates. Additionally, lifestyle factors such as high BMI and limited preoperative physical activity negatively impacted recovery speed and functional outcomes. Transthyretin was associated with increased pain, longer hospital stays, and higher infection rate.

Conclusion : This review underscores that preoperative NLR, Hemoglobin A1c, albumin/prealbumin, BMI, physical activity, and transthyretin levels are significant predictors of spine surgery recovery. Integrating these indicators into pre-surgical assessments may help stratify patient risk and tailor postoperative rehabilitation. Further studies should test how improving these predictors preoperatively can affect spinal surgery recovery.