Is preoperative albumin level associated with wound complications after oncologic surgery for spinal metastases? An ACS-NSQIP analysis.

Abstract

Background: Wound complications following metastatic spine tumor surgery (MSTS) can significantly impact patient recovery and delay adjuvant therapy. While nutritional status has been implicated in surgical outcomes, the specific relationship between preoperative albumin levels and wound complications after MSTS remains incompletely understood. We investigated the association between preoperative albumin levels and wound complications following MSTS.

Methods: We analyzed the data of 2195 patients who underwent MSTS from the American College of Surgeons National Surgical Quality Improvement Program database (2018-2023). The primary endpoint was a composite of wound complications (dehiscence, superficial/deep incisional infections, organ/space surgical site infections) within 30 days. The secondary endpoint was reoperation due to wound complications. Univariable and multivariable logistic regression analyses assessed associations between patient/operative characteristics and outcomes, with albumin level evaluated both: continuously and categorically.

Results: Wound complications occurred in 4 % (88/2195) of patients, with 22 % (19/88) requiring reoperation. Complications were observed in 3 % of normoalbuminemic patients, 5 % with mild hypoalbuminemia, and 8 % with severe hypoalbuminemia. Multivariable analysis controlling for chronic steroid use, operative time, perioperative transfusion, and posterior instrumentation revealed that each 1 g/dL increase in preoperative albumin was independently associated with 31 % lower odds of wound complications (OR 0.68 [95 % CI 0.49-0.95]; p = 0.026). Severe hypoalbuminemia (<2.5 g/dL) more than doubled complication risk compared to normal levels (OR 2.15 [95 % CI 1.01-4.56]; p = 0.045). Preoperative albumin level was not significantly associated with reoperation due to wound complications.

Conclusions: These findings suggest the potential value of albumin as a modifiable risk factor in preoperative assessment for candidates of MSTS. Future prospective studies should validate these findings and investigate whether nutritional optimization targeting albumin levels can reduce complications in this vulnerable patient population.