Albumin Levels Stratify Risk of 30-Day Complications Following Posterior Cervical Fusion.
Academic Article
Overview
abstract
STUDY DESIGN: Retrospective cohort study. OBJECTIVE: The purpose of this study was to establish preoperative albumin thresholds to stratify the risk of 30-day complications after PCF. SUMMARY OF BACKGROUND DATA: Over the past 2 decades, rates of posterior cervical fusion (PCF) have risen significantly, coinciding with advancements in surgical techniques and an aging population, but with complications occurring in up to 25% of cases. Hypoalbuminemia may increase risk for complications after spine surgery, but there are no studies that utilize data-driven methods to derive precise thresholds to risk-stratify patients. Although the association between malnutrition and subpar outcomes has been investigated, there remains a paucity of literature examining PCF. METHODS: A retrospective cohort analysis was performed using a national database. Patients with a preoperative measurement of albumin before PCF were included, whereas patients undergoing multilevel PCF were excluded. Stratum-specific likelihood ratio (SSLR) analysis was conducted to determine data-driven albumin strata that minimized the likelihood of complications within 30 days of PCF. Multivariable regression was utilized to stratify the risk of 30-day major and minor complications after PCF. RESULTS: SSLR analysis identified 3 albumin strata: 1-3.2g/dL, 3.2-3.6g/dL, and 3.6+g/dL before surgery. Compared with the 3.6+ g/dL stratum, the 1-3.2g/dL (OR: 3.02) and 3.2-3.6g/dL (OR: 1.65) cohorts had significant and sequentially increasing odds of 30-day all-cause complications after PCF ( P < 0.05 for all). CONCLUSIONS: This study established data-driven preoperative albumin thresholds that correlate with an increased risk of 30-day all-cause complications after PCF. To the best of our knowledge, this is the first study to demonstrate the variable and stratifiable risk of complications on the basis of preoperative albumin levels. These findings assist spine surgeons in stratifying patient risk based on preoperative albumin levels, enabling more informed decision-making and potentially improving patient outcomes.
