Background

Preoperative optimization in patients undergoing posterior spinal fusion is essential to limit the number and severity of postoperative complications. Here, we, additionally, evaluated the impact of hypoalbuminemia on morbidity and mortality after posterior spinal fusion surgery.

Methods

This retrospective analysis was performed using data from a prospective multicentric database (ACSNSQIP:2015-2020) regarding patients undergoing posterior spinal fusions. Factors studied included; baseline demographics and 30-day postoperative complications (i.e., reoperations, readmissions, and mortality rates).

Results

There were 6805 patients who met the inclusion criteria. They averaged 62 years of age and had an average BMI of 30.2. Within the 30-day postoperative period, 634 (9.3%) sustained complications; 467 (6.9%) were readmitted, 263 (3.9%) required reoperations, and 37 (0.5%) expired. Although multiple preoperative risk factors were analyzed, hypoalbuminemia, severe hypoalbuminemia, and dialysis were the strongest independent risk factors associated with complications (i.e., reoperations, readmissions, and mortality).

Conclusion

Hypoalbuminemia, severe hypoalbuminemia, and dialysis were significant predictors for morbidity and mortality after posterior spinal fusion surgery.

Study DesignA retrospective cohort study.ObjectiveTo evaluate the utility of routine preoperative urinalysis as a predictor of postoperative complications following elective lumbar fusion surgery (ELFS).MethodsThis study included a retrospective review of patients aged ≥18 years-old who underwent ELFS for degenerative pathology between 2018 to 2022 at a single academic institution. Patients were categorized into 3 groups: No Urinalysis (No-UA), Negative Urinalysis (Negative-UA), and Positive Urinalysis (Positive-UA). A retrospective review of medical records was conducted including patient characteristics and clinical factors of interest. Emergency department (ED) visits and return to the operating room (OR) within 3-months postoperatively were recorded. Statistical analyses were performed using bivariate and multivariate analysis.ResultsA total of 493 patients were included. Despite having higher rates of preoperative antibiotics administered, patients with a positive urinalysis were significantly more likely to present with postoperative urinary tract infections (UTIs) than the No-UA and Negative-UA groups. No significant differences were seen in other types of complications including pneumonia, bacteremia, superficial wound infections, deep wound infections, and wound dehiscence between the 3 groups. Additionally, rates of return to OR, return to ED, reinsertion of foley catheters, duration of indwelling catheterization, and hospital length of stay had no significant differences between the groups.ConclusionThis study suggests there may be a limited role in performing routine preoperative urinalysis prior to ELFS. This study may help further improve preoperative assessment guidelines and assist with patient counseling and considerations prior to elective lumbar fusion surgery.