Preoperative hypoalbuminemia and dialysis increase morbidity/mortality after spine surgery for primary pyogenic spinal infections (ACS-NSQIP Study)

Gaston Camino-Willhuber; Austin Franklin; Katherine Rosecrance; Sarah Oyadomari; Justin Chan; Fernando Holc; Sohaib Hashmi; Michael Oh; Nitin Bhatia; Juan Emmerich; Yu-Po Lee

doi:10.25259/SNI_330_2022

Preoperative hypoalbuminemia and dialysis increase morbidity/mortality after spine surgery for primary pyogenic spinal infections (ACS-NSQIP Study)

Surg Neurol Int. 2022 May 6:13:193. doi: 10.25259/SNI_330_2022. eCollection 2022.

Authors

Affiliations

¹ Department of Orthopedics, Institute of Orthopedics "Carlos E. Ottolenghi," Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
² School of Medicine, University of California Irvine.
³ Department of Orthopaedics, University of California Irvine, Orange, California, United States.
⁴ Department of Neurosurgery, University of California Irvine, Orange, California, United States.
⁵ Department of Neurological Surgery, Children's Hospital La Plata, La Plata, Argentina.

Abstract

Background: We analyzed the role of hypoalbuminemia, dialysis, and other risk factors that increase morbidity/ mortality following surgery for primary pyogenic spinal infections (PSIs). The American College of Surgeons' National Surgical Quality Improvement Program (ACS-NSQIP) that included 627 patients was utilized as our database.

Methods: Primary spinal surgery for spondylodiscitis was evaluated in a ACS-NSQIP database involving 627 patients between 2010 and 2019. Outcome assessment included evaluation of 30-day postoperative morbidity, and mortality rates.

Results: Within 30 postoperative days, complications occurred in 14.6% (92/627) of patients; 59 (9.4%) required readmission, and 39 (6.2%) required additional surgery. The most common complications were: wound infections, pneumonia, septic shock, and death (1.8%). Hypoalbuminemia (i.e., significantly associated with unplanned readmission and reoperation), and dialysis were the two major risk factors contributing to increased perioperative morbidity and mortality.

Conclusion: Among 627 ACS-NSQIP patients undergoing primary surgery for PSIs, hypoalbuminemia and dialysis were associated with higher risks of major perioperative morbidity (i.e., within 30 postoperative days - mostly readmissions and reoperations) and mortality.

Keywords: Dialysis; Hypoalbuminemia; Readmission; Reoperation; Spondylodiscitis.