Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines for Perioperative Spine: Preoperative Nutritional Assessment

BACKGROUND: Preoperative malnutrition has been implicated in adverse events after elective surgery, potentially impacting patient outcomes. OBJECTIVE: As a potentially modifiable risk factor, we sought to determine which assessments of nutritional status were associated with specific adverse events after spine surgery. In addition, we explored if a preoperative nutritional improvement intervention may be beneficial in lowering the rates of these adverse events. METHODS: The literature search yielded 115 abstracts relevant to the PICO (patient/population, intervention, comparison, and outcomes) questions included in this chapter. The task force selected 105 articles for full text review, and 13 met criteria for inclusion in this systematic review. RESULTS: Malnutrition, assessed preoperatively by a serum albumin <3.5 g/dL or a serum prealbumin <20 mg/dL, is associated with a higher rate of surgical site infections (SSIs), other wound complications, nonunions, hospital readmissions, and other medical complications after spine surgery. A multimodal nutrition management protocol decreases albumin and electrolyte deficiencies in patients with normal preoperative nutritional status. It also improves overall complication rates but does not specifically impact SSIs. CONCLUSION: It is recommended to assess nutritional status using either serum albumin or prealbumin preoperatively in patients undergoing spine surgery.

Automated summary

Preoperative malnutrition, as indicated by low serum albumin or prealbumin levels, is associated with higher rates of adverse events after spine surgery, including surgical site infections, wound complications, nonunions, hospital readmissions, and other medical complications. A multimodal nutrition management protocol can decrease deficiencies in albumin and electrolytes in patients with normal preoperative nutritional status, leading to an improvement in overall complication rates but not specifically impacting surgical site infections.