Prevalence and Impact of Malnutrition on Postoperative Outcomes in Patients Undergoing Posterior Cervical Spinal Instrumentation.

Abstract

A retrospective study using the TriNetX Research Network. Evaluate the prevalence of malnutrition and its impact on postoperative complications in patients undergoing posterior cervical spinal instrumentation. Malnutrition, commonly identified by serum albumin <3.5 g/dL, has been linked to surgical site infections (SSI) and wound dehiscence (WD). However, data specific to posterior cervical spine surgery remain limited. Using TriNetX, adult patients who had single- or multilevel posterior cervical spine instrumentation with diagnoses including stenosis, myelopathy, disc disorder, radiculopathy, spondylosis, or spondylolisthesis, and a preoperative albumin measurement within 30 days, were identified. Patients grouped by albumin <3.5 g/dL or ≥3.5 g/dL. Propensity score matching controlled for age, sex, race, and comorbidities. Primary outcomes were SSI and WD, with reoperation as a secondary outcome, identified within 90 days postsurgery. Of 7607 patients (mean age: 61.8±12.6 y, 54.8% male), 1790 (23.5%) had albumin <3.5 g/dL. Before matching, malnourished patients had higher odds of SSI/WD (OR=1.400, 95% CI: 1.105-1.775) and reoperation (OR=1.472, 95% CI: 1.241-1.745) compared with patients with adequate nutritional status. After matching (1785 patients/group), malnourished patients showed elevated odds of SSI/WD (OR=1.377, 95% CI: 1.016-1.866) and reoperation (OR=1.380, 95% CI: 1.111-1.716) within 90 days. In this large retrospective matched analysis, malnutrition (albumin <3.5 g/dL) was present in 23.5% of adults undergoing posterior cervical spinal instrumentation. Malnourished patients had ∼40% higher odds of postoperative SSI, WD, and reoperation within 90 days compared with those with albumin ≥3.5 g/dL. These complications prolong hospitalization, increase health care costs, and negatively affect patient outcomes. Minimizing them is critical, and malnutrition is a modifiable risk factor. Our findings underscore the importance of routine nutritional evaluation and interventions before posterior cervical spine surgery. Further studies should explore nutritional supplementation and its impact on reducing postoperative morbidity in malnourished patients. Level III.