术前营养状况对老年脊柱手术患者发病率和死亡率的影响：老年营养风险指数的作用

Impact of preoperative nutritional status on morbidity and mortality in geriatric patients undergoing spine surgery: Role of geriatric nutritional risk index.

作者信息

Elsamadicy Aladine A, Serrato Paul, Belkasim Selma, Ghanekar Shaila D, Hansen Justice, Khalid Syed I, Lo Sheng-Fu Larry, Sciubba Daniel M

机构信息

Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, United States.

出版信息

Clin Neurol Neurosurg. 2025 Sep;256:109000. doi: 10.1016/j.clineuro.2025.109000. Epub 2025 Jun 10.

DOI:10.1016/j.clineuro.2025.109000

PMID:40513144

Abstract

BACKGROUND

Malnutrition is a risk factor for poor surgical outcomes amongst the elderly. However, the association between malnutrition and outcomes in geriatric patients undergoing spine surgery has been understudied. The aim of this study was to assess associations between malnutrition and 30-day morbidity and mortality in geriatric patients undergoing spine surgery.

METHODS

A retrospective cohort study was performed using the American College of Surgeons National Surgical Quality Improvement Program database. All geriatric patients (≥ 65 years old) were categorized by Geriatric Nutritional Risk Index (GNRI) score: Normal, Malnourished, and Severely Malnourished. Patient demographics, comorbidities, and adverse events (AEs) were assessed. Multivariable logistic regression analyses identified independent predictors of 30-day postoperative AEs, extended length of stay (LOS), non-routine discharge (NRD), unplanned readmission, and mortality.

RESULTS

Of the 79,160 patients identified, 58,906 (74.4 %) had Normal nutritional status, 12,184 (15.4 %) were Malnourished, and 8070 (10.2 %) were Severely Malnourished. The Malnourished and Severely Malnourished cohorts had significantly increased proportion of AEs (p < 0.001) and a longer LOS (p < 0.001). The Malnourished and Severely Malnourished cohorts had significantly increased proportions of NRD (p < 0.001), unplanned readmissions (p < 0.001), and 30-day mortality (p < 0.001). On multivariable analysis, Malnourished and Severely Malnourished statuses, respectively, were independently associated with any AE (p < 0.001), extended LOS (p < 0.001), 30-day unplanned readmission (p < 0.001), NRD (p < 0.001), and 30-day mortality (p < 0.001).

CONCLUSION

Our study suggests that preoperative GNRI-defined malnutrition may increase the risk of adverse postoperative outcomes following spine surgery in geriatric patients.

摘要

背景

营养不良是老年人手术预后不良的一个风险因素。然而，营养不良与老年脊柱手术患者预后之间的关联尚未得到充分研究。本研究的目的是评估老年脊柱手术患者营养不良与30天发病率和死亡率之间的关联。

方法

使用美国外科医师学会国家外科质量改进计划数据库进行一项回顾性队列研究。所有老年患者（≥65岁）根据老年营养风险指数（GNRI）评分进行分类：正常、营养不良和严重营养不良。评估患者的人口统计学、合并症和不良事件（AE）。多变量逻辑回归分析确定了术后30天AE、延长住院时间（LOS）、非常规出院（NRD）、非计划再入院和死亡率的独立预测因素。

结果

在79160名确定的患者中，58906名（74.4%）营养状况正常，12184名（15.4%）营养不良，8070名（10.2%）严重营养不良。营养不良和严重营养不良队列的AE比例显著增加（p<0.001），住院时间更长（p<0.001）。营养不良和严重营养不良队列的NRD、非计划再入院和30天死亡率比例显著增加（p<0.001）。多变量分析显示，营养不良和严重营养不良状态分别与任何AE（p<0.001）、延长住院时间（p<0.001）、30天非计划再入院（p<0.001）、NRD（p<0.001）和30天死亡率（p<0.001）独立相关。