Relation of preoperative pre-albumin and transferrin to 30-day risk of complication in elective spine surgical patients

Back pain is commonly reported among adults in the U.S., it is the second most common reason adults seek medical treatment. There is steady growth in the number of older adults seeking spine surgeries, especially complex surgeries. Additionally, the number of citizens over the age of 65 is steadily increasing and will continue to increase over the next several decades. The rising number of older adults seeking spine surgery raises concern for the well-being of this population given the risk of complications in spine surgery. It is imperative for clinicians to understand all potential risk factors for their patient’s undergoing surgery. Protein malnutrition is a risk factor for postoperative morbidity and mortality. While there is no universally accepted pre-operative measure of nutrition status, certain blood biomarkers are recognized as clinically important in evaluating patient’s pre-surgical nutrition status. To further evaluate pre-surgical biomarkers and risk of complications we conducted a retrospective cohort study of adults aged 50 years and over undergoing elective spine surgery over the course of 12 months. After creating a case list from the electronic medical record system, data was collected on each patient fitting predetermined inclusion and exclusion criteria. The relation between the biomarkers and risk of complications was assessed using log-binomial regression, pre-albumin and transferrin risk ratios and 95% confidence intervals were estimated. After adjusting for confounding factors, the prealbumin relative risk of any complication was 1.1 (95% CI: 0.8-1.5), or 10% greater risk among patients with pre-albumin level above the median than the risk of those with pre-albumin level below the median. In the same model, the transferrin adjusted relative risk of any complication was 1.1 (95% CI: 0.8-1.5). In this retrospective cohort study of 211 patients, for adults aged 50 years and older, we found that preoperative nutrition, as defined by the biomarkers pre-albumin and transferrin was not an independent risk factor for medical complications within 30 days of elective spine surgery.

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