The impact of serum albumin levels on cervical spine surgery outcomes: a MSSIC study

Document Type

Conference Proceeding

Publication Date

9-1-2024

Publication Title

Spine J

Abstract

BACKGROUND CONTEXT: Serum albumin, a marker of nutritional status, has been identified as a significant predictor of postoperative outcomes across various surgical fields. Patients with serum albumin levels < 3.5, indicative of poor nutritional status, are traditionally nutritionally optimized prior to undergoing operative intervention. However, there is a paucity of data regarding the outcomes of patients with albumin levels ranging between 3.5 to 4. PURPOSE: This study aims to determine if there is an association between albumin levels between 3.5 and 4 g/dL and postoperative outcomes in cervical spine surgery, and to determine if these patients may benefit from preoperative optimization. STUDY DESIGN/SETTING: N/A PATIENT SAMPLE: N/A OUTCOME MEASURES: N/A METHODS: A Michigan Spine Surgery Improvement Collaborative (MSSIC) database search was performed for cervical spine fusion surgeries between January 2020 and December 2022. 6,826 patients were analyzed retrospectively. Patients were grouped by preoperative serum albumin level: < 3.5 g/dL, 3.5–3.7 g/dL, 3.8–4 g/dL, and >4 g/dL. Measured postoperative outcomes included urinary retention, readmission within 30 and 90 days, surgical site infection (SSI), return to the operating room, dysphagia, and length of stay (LOS) ≥ 4 days. RESULTS: A total of 6,826 cervical fusion cases were included in the analysis. Multivariate analysis used cases with albumin >4 g/dL as the reference group. Urinary retention rates among albumin levels did not vary significantly from the reference group. Albumin < 3.5 g/dL was associated with increased readmission at 90 days (incidence rate ratio 1.72, CI [1.06-2.77], p=0.027), increased LOS > 4 days (IRR 1.39, CI [1.29-1.51], p< 0.001) and higher levels of dysphagia (IRR 1.78, CI [1.24-2.56], p = 0.002). Albumin 3.5-3.7 g/dL was associated with increased readmission at 90 days (IRR 1.92, CI [1.47-2.52], p< 0.001), increased readmission at 30 days (IRR 1.97, CI [1.28-3.03], p=0.002), and increased LOS > 4 days (IRR 1.31, CI [1.23-1.40], p < 0.001). Albumin 3.8-4 g/dL was associated with increased readmission at 90 days (IRR 1.35, CI [1.13-1.61], p=0.001), increased readmission at 30 days (IRR 1.40, CI [1.08-1.83], p=0.012), and increased LOS > 4 days (IRR 1.14, CI [1.09-1.20], p< 0.001). CONCLUSIONS: Albumin levels < 3.5 g/dL is the traditional cutoff for preoperative nutritional optimization. Albumin 3.5-3.7 g/dL and 3.8-4 g/dL had an increased risk of readmission at 90 days and increased LOS similar to albumin < 3.5 g/dL. This study suggests a higher albumin cutoff than 3.5 g/dL may be beneficial in limiting poor postoperative outcomes in cervical spine surgery. FDA Device/Drug Status: This abstract does not discuss or include any applicable devices or drugs.

Volume

24

Issue

9

First Page

S171

Last Page

S172

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