Impact of serum albumin levels on lumbar spine surgery outcomes: a Michigan State Surgery Improvement Collaborative study

Document Type

Conference Proceeding

Publication Date

9-1-2024

Publication Title

Spine J

Abstract

BACKGROUND CONTEXT: Serum albumin has been identified as a significant predictor of postoperative complications. Traditionally, patients with serum albumin levels < 3.5 g/dL are considered malnourished and are nutritionally optimized prior to surgery. However, there is a paucity of data regarding the outcomes of patients with albumin levels greater than 3.5 g/dL but less than 4.0 g/dL. PURPOSE: This study aims to examine whether patients with albumin levels between 3.5-4g/dL have an increased risk of complications and could benefit from nutritional optimization prior to lumbar spine surgery. STUDY DESIGN/SETTING: N/A PATIENT SAMPLE: N/A OUTCOME MEASURES: N/A METHODS: The Michigan Spine Surgery Improvement Collaborative (MSSIC) database contained 15,629 lumbar fusion surgeries between January, 2020 and December, 2022. Patients were grouped based on serum albumin levels: < 3.5g/dL, 3.5-3.7g/dL, 3.8-4g/dL, and >4g/dL. Outcomes measured included urinary retention, surgical site infection (SSI), wound dehiscence, readmission within 30 and 90 days, return to OR, and length of stay (LOS) ≥4 days. Patients with albumin levels >4g/dL comprised the reference group. RESULTS: This study included a total of 15,393 lumbar cases. Albumin of < 3.5 g/dL was associated with an increased risk of urinary retention (Incidence Rate Ratio 1.40, CI [1.08-1.83], p=0.012), Surgical Site Infection (2.35 [1.71-3.23], p< 0.001), readmission at 30 days (1.87 [1.49-2.34], p< 0.001) and 90 days (1.95 [1.58-2.40], p< 0.001), return to OR (2.13 [1.65-2.75], p< 0.001), and LOS ≥4 days (1.32 [1.21-1.44], p< 0.001). Albumin of 3.5– 3.7 g/dL was associated with increased risk of readmission at 30 days (1.21 [1.001-1.45], p=0.048) and 90 days (1.28 [1.08-1.52], p=0.005), and LOS ≥4 days (1.22 [1.16-1.29], p< 0.001). Albumin of 3.8–4.0 g/dL was associated with an increased risk of LOS ≥4 days (1.08 [1.04-1.11], p< 0.001). CONCLUSIONS: Serum albumin of < 3.5 g/dL was strongly associated with increased complications and increased return to OR, length of stay, and 30- and 90-day readmissions in elective lumbar spine procedures. Levels of 3.5-3.7 g/dL had increased risk of readmission and LOS, whereas levels of 3.8-4.0 g/dL did not show increased risk. These findings suggest that a goal albumin of >3.7 g/dL may improve postoperative outcomes in elective lumbar spine surgery. FDA Device/Drug Status: This abstract does not discuss or include any applicable devices or drugs.

Volume

24

Issue

9

First Page

S21

Find It @ Sladen

Share

COinS