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J Neurol Surg A Cent Eur Neurosurg 2019; 80(06): 470-474
DOI: 10.1055/s-0039-1693031
Original Article
Georg Thieme Verlag KG Stuttgart · New York

A Novel Prognostic Marker in Patients Undergoing Spinal Surgery: Prognostic Nutritional Index

Arsal Acarbaş
1   Department of Neurosurgery, Faculty of Medicine, Mugla Sitki Kocman University, Muğla, Turkey
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Further Information

Publication History

27 December 2018

18 March 2019

Publication Date:
29 August 2019 (online)

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Abstract

Objective The relationship of a preoperative Prognostic Nutritional Index (PNI) with perioperative adverse events (PAEs) other than delirium has never been described in patients undergoing spinal surgery. We aimed to evaluate the impact of admission PNI on the outcome of patients undergoing spinal surgery.

Methods Medical records of 408 consecutive patients 50 years or older undergoing spinal surgery were reviewed. Patients' information including demographic data, routine preoperative laboratory tests, and PNI were collected to assess the association between these factors and PAEs. The PNI was calculated from this formula: 10 × serum albumin (g/dL) + 0.005 × total lymphocyte count/mm3. Receiver operating characteristic curve analysis was performed to determine the cutoff value of the PNI.

Results PAEs occurred in 61 (14.9%) of the patients. Older patients and those with more comorbid conditions such as atrial fibrillation, chronic renal failure, history of malignancy, and diabetes mellitus tended to have a higher rate of PAEs. Patients with PAEs had higher C-reactive protein (4.4 ± 5.4 vs 2.2 ± 3.0 mg/dL; p < 0.001) but had lower hemoglobin levels (12.2 ± 1.57 vs 13.1 ± 1.84 g/dL; p < 0.001) on admission. Patients who had PAEs had a significantly lower preoperative PNI (46.1 ± 4.4 vs 51.9 ± 5.8; p < 0.001) compared with patients without a PAE. Multivariate analysis showed that age (odds ratio [OR]: 1.23; 95% confidence interval [CI] 0.76–1.35; p < 0.04), PNI < 47.7 (OR: 2.51; 95% CI, 1.188–5.477; p = 0.008) and the presence of diabetes (OR: 3.23; 95% CI, 11.326–7.474; p = 0.004) were significant and independent predictors of PAEs.

Conclusion This study is the first to demonstrate that a lower preoperative PNI is associated with PAEs in patients undergoing spinal surgery.

Keywords

Prognostic Nutritional Index - spinal surgery - perioperative adverse event
 

  • References

  • 1 Deyo RA, Mirza SK, Martin BI, Kreuter W, Goodman DC, Jarvik JG. Trends, major medical complications, and charges associated with surgery for lumbar spinal stenosis in older adults. JAMA 2010; 303 (13) 1259-1265
    CrossrefPubMedGoogle Scholar
  • 2 Ugiliweneza B, Kong M, Nosova K. , et al. Spinal surgery: variations in health care costs and implications for episode-based bundled payments. Spine 2014; 39 (15) 1235-1242
    CrossrefPubMedGoogle Scholar
  • 3 Rossi VJ, Ahn J, Bohl DD, Tabaraee E, Singh K. Economic factors in the future delivery of spinal healthcare. World J Orthop 2015; 6 (05) 409-412
    CrossrefPubMedGoogle Scholar
  • 4 Wang MY, Widi G, Levi AD. The safety profile of lumbar spinal surgery in elderly patients 85 years and older. Neurosurg Focus 2015; 39 (04) E3
    PubMedGoogle Scholar
  • 5 Goz V, Rane A, Abtahi AM, Lawrence BD, Brodke DS, Spiker WR. Geographic variations in the cost of spine surgery. Spine 2015; 40 (17) 1380-1389
    CrossrefPubMedGoogle Scholar
  • 6 Cao J, Kong L, Meng F, Zhang Y, Shen Y. Impact of obesity on lumbar spinal surgery outcomes. J Clin Neurosci 2016; 28: 1-6
    CrossrefPubMedGoogle Scholar
  • 7 Pereira BJ, de Holanda CV, Ribeiro CA. , et al. Spinal surgery for degenerative lumbar spine disease: predictors of outcome. Clin Neurol Neurosurg 2016; 140: 1-5
    CrossrefPubMedGoogle Scholar
  • 8 Atlas SJ, Keller RB, Robson D, Deyo RA, Singer DE. Surgical and nonsurgical management of lumbar spinal stenosis: four-year outcomes from the Maine lumbar spine study. Spine 2000; 25 (05) 556-562
    CrossrefPubMedGoogle Scholar
  • 9 Guyot JP, Cizik A, Bransford R, Bellabarba C, Lee MJ. Risk factors for cardiac complications after spine surgery. Evid Based Spine Care J 2010; 1 (02) 18-25
    Article in Thieme ConnectPubMedGoogle Scholar
  • 10 Ogawa M, Izawa KP, Satomi-Kobayashi S. , et al. Poor preoperative nutritional status is an important predictor of the retardation of rehabilitation after cardiac surgery in elderly cardiac patients. Aging Clin Exp Res 2017; 29 (02) 283-290
    CrossrefPubMedGoogle Scholar
  • 11 Shoji F, Matsubara T, Kozuma Y. , et al. Preoperative Geriatric Nutritional Risk Index: a predictive and prognostic factor in patients with pathological stage I non-small cell lung cancer. Surg Oncol 2017; 26 (04) 483-488
    CrossrefPubMedGoogle Scholar
  • 12 Jones JM. The methodology of nutritional screening and assessment tools. J Hum Nutr Diet 2002; 15 (01) 59-71 ; quiz 73–75
    CrossrefPubMedGoogle Scholar
  • 13 Nozoe T, Kohno M, Iguchi T. , et al. The prognostic nutritional index can be a prognostic indicator in colorectal carcinoma. Surg Today 2012; 42 (06) 532-535
    CrossrefPubMedGoogle Scholar
  • 14 Tokunaga R, Sakamoto Y, Nakagawa S. , et al. Prognostic Nutritional Index predicts severe complications, recurrence, and poor prognosis in patients with colorectal cancer undergoing primary tumor resection. Dis Colon Rectum 2015; 58 (11) 1048-1057
    CrossrefPubMedGoogle Scholar
  • 15 Yang Z, Zhang B, Hou L, Xie Y, Cao X. Pre-operative prognostic nutritional index predicts the outcomes for triple-negative breast cancer. Tumour Biol 2014; 35 (12) 12165-12171
    CrossrefPubMedGoogle Scholar
  • 16 Hong S, Zhou T, Fang W. , et al. The Prognostic Nutritional Index (PNI) predicts overall survival of small-cell lung cancer patients. Tumour Biol 2015; 36 (05) 3389-3397
    CrossrefPubMedGoogle Scholar
  • 17 Cheng YL, Sung SH, Cheng HM. , et al. Prognostic Nutritional Index and the risk of mortality in patients with acute heart failure. J Am Heart Assoc 2017; 6 (06) e004876
    PubMedGoogle Scholar
  • 18 Hayıroğlu Mİ, Keskin M, Keskin T. , et al. A novel independent survival predictor in pulmonary embolism: Prognostic Nutritional Index. Clin Appl Thromb Hemost 2018; 24 (04) 633-639
    CrossrefPubMedGoogle Scholar
  • 19 Okada S, Shimada J, Teramukai S. , et al. Risk stratification according to the Prognostic Nutritional Index for predicting postoperative complications after lung cancer surgery. Ann Surg Oncol 2018; 25 (05) 1254-1261
    CrossrefPubMedGoogle Scholar
  • 20 Zheng HL, Lu J, Li P. , et al. Effects of preoperative malnutrition on short- and long-term outcomes of patients with gastric cancer: can we do better?. Ann Surg Oncol 2017; 24 (11) 3376-3385
    CrossrefPubMedGoogle Scholar
  • 21 Mosquera C, Koutlas NJ, Edwards KC. , et al. Impact of malnutrition on gastrointestinal surgical patients. J Surg Res 2016; 205 (01) 95-101
    CrossrefPubMedGoogle Scholar
  • 22 Adogwa O, Elsamadicy AA, Mehta AI, Cheng J, Bagley CA, Karikari IO. Preoperative nutritional status is an independent predictor of 30-day hospital readmission after elective spine surgery. Spine 2016; 41 (17) 1400-1404
    CrossrefPubMedGoogle Scholar
  • 23 Tempel Z, Grandhi R, Maserati M. , et al. Prealbumin as a serum biomarker of impaired perioperative nutritional status and risk for surgical site infection after spine surgery. J Neurol Surg A Cent Eur Neurosurg 2015; 76 (02) 139-143
    Article in Thieme ConnectPubMedGoogle Scholar
  • 24 Schoenfeld AJ, Carey PA, Cleveland III AW, Bader JO, Bono CM. Patient factors, comorbidities, and surgical characteristics that increase mortality and complication risk after spinal arthrodesis: a prognostic study based on 5,887 patients. Spine J 2013; 13 (10) 1171-1179
    CrossrefPubMedGoogle Scholar
  • 25 Salvetti DJ, Tempel ZJ, Goldschmidt E. , et al. Low preoperative serum prealbumin levels and the postoperative surgical site infection risk in elective spine surgery: a consecutive series. J Neurosurg Spine 2018; 29 (05) 549-552
    CrossrefPubMedGoogle Scholar
  • 26 Puvanesarajah V, Jain A, Kebaish K. , et al. Poor nutrition status and lumbar spine fusion surgery in the elderly: readmissions, complications, and mortality. Spine 2017; 42 (13) 979-983
    CrossrefPubMedGoogle Scholar
  • 27 Bohl DD, Shen MR, Mayo BC. , et al. Malnutrition predicts infectious and wound complications following posterior lumbar spinal fusion. Spine 2016; 41 (21) 1693-1699
    CrossrefPubMedGoogle Scholar
  • 28 Lee JY, Kim HI, Kim YN. , et al. Clinical significance of the prognostic nutritional index for predicting short- and long-term surgical outcomes after gastrectomy: a retrospective analysis of 7781 gastric cancer patients. Medicine (Baltimore) 2016; 95 (18) e3539
    PubMedGoogle Scholar
  • 29 Zhou XW, Dong H, Yang Y. , et al. Significance of the prognostic nutritional index in patients with glioblastoma: a retrospective study. Clin Neurol Neurosurg 2016; 151: 86-91
    CrossrefPubMedGoogle Scholar
  • 30 Oe S, Togawa D, Yamato Y. , et al. Preoperative age and prognostic nutritional index are useful factors for evaluating postoperative delirium among patients with adult spinal deformity. Spine (Phila Pa 1976) 2019; 44 (07) 472-478
    CrossrefPubMedGoogle Scholar