Aladine A Elsamadicy, Paul Serrato, Sina Sadeghzadeh, Shaila Ghanekar, Syed I Khalid, Sheng-Fu Larry Lo, Daniel M Sciubba
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Elderly (≥ 65 years of age) patients undergoing laminectomy or corpectomy for extradural spinal tumor metastases were identified using International Classification of Diseases, 9th and 10th Revision and Current Procedural Terminology codes. Patients with missing data on sex, preoperative albumin, height, or weight were excluded. The study population was categorized by GNRI score: normal, malnourished, or severely malnourished. Using receiver operating characteristic (ROC) and multivariable analyses, the authors compared the discriminative thresholds and independent associations of GNRI, the 5-item modified frailty index (mFI-5), and older patient age with any adverse event (AE), extended hospital length of stay (LOS), nonroutine discharge, and 30-day mortality.</p><p><strong>Results: </strong>Of the 659 patients identified, 277 (42.0%) had normal nutritional status, 163 (24.7%) were malnourished, and 219 (33.2%) were severely malnourished. The severely malnourished cohort had significantly increased proportions of electrolyte abnormalities (p = 0.019) and anemia (p < 0.001), with a significant decrease in BMI and albumin levels across cohorts (p < 0.001). Malnourished and severely malnourished patients had significantly longer LOS (9.1 ± 6.2 days and 12.5 ± 8.6 days, respectively, vs 8.6 ± 7.1 days for patients categorized as normal, p < 0.001) and nonroutine discharge (57.9% and 66.7%, respectively, vs 39.7% for normal, p < 0.001). The severely malnourished cohort had significantly increased 30-day mortality (17.4% vs 6.5% for normal and 13.5% for malnourished, p = 0.001). On multivariable analysis, severely malnourished status was independently associated with any AE (adjusted odds ratio [aOR] 1.59, p = 0.036), extended LOS (aOR 2.17, p = 0.001), nonroutine discharge (aOR 1.99, p = 0.001), and 30-day mortality (aOR 2.28, p = 0.013). Malnourished status was independently associated with nonroutine discharge (aOR 1.84, p = 0.005). In ROC analysis, GNRI outperformed the mFI-5 (p = 0.318, p = 0.031, p < 0.009, and p = 0.026, respectively) and patient age (p = 0.018, p < 0.001, p = 0.014, and p = 0.034, respectively) in predicting 30-day AEs, extended LOS, nonroutine discharge, and 30-day mortality.</p><p><strong>Conclusions: </strong>This study suggests that preoperative GNRI-defined malnutrition is associated with a higher risk of adverse postoperative outcomes in elderly patients undergoing spine surgery for metastatic spinal tumors.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. 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This study aimed to evaluate the associations between preoperative nutritional status, as measured by the GNRI, and postoperative morbidity and mortality in elderly patients undergoing spine surgery for metastatic spinal tumors.</p><p><strong>Methods: </strong>A retrospective cohort study was performed using the 2011-2022 National Surgical Quality Improvement Program database of the American College of Surgeons. Elderly (≥ 65 years of age) patients undergoing laminectomy or corpectomy for extradural spinal tumor metastases were identified using International Classification of Diseases, 9th and 10th Revision and Current Procedural Terminology codes. Patients with missing data on sex, preoperative albumin, height, or weight were excluded. The study population was categorized by GNRI score: normal, malnourished, or severely malnourished. Using receiver operating characteristic (ROC) and multivariable analyses, the authors compared the discriminative thresholds and independent associations of GNRI, the 5-item modified frailty index (mFI-5), and older patient age with any adverse event (AE), extended hospital length of stay (LOS), nonroutine discharge, and 30-day mortality.</p><p><strong>Results: </strong>Of the 659 patients identified, 277 (42.0%) had normal nutritional status, 163 (24.7%) were malnourished, and 219 (33.2%) were severely malnourished. The severely malnourished cohort had significantly increased proportions of electrolyte abnormalities (p = 0.019) and anemia (p < 0.001), with a significant decrease in BMI and albumin levels across cohorts (p < 0.001). Malnourished and severely malnourished patients had significantly longer LOS (9.1 ± 6.2 days and 12.5 ± 8.6 days, respectively, vs 8.6 ± 7.1 days for patients categorized as normal, p < 0.001) and nonroutine discharge (57.9% and 66.7%, respectively, vs 39.7% for normal, p < 0.001). The severely malnourished cohort had significantly increased 30-day mortality (17.4% vs 6.5% for normal and 13.5% for malnourished, p = 0.001). On multivariable analysis, severely malnourished status was independently associated with any AE (adjusted odds ratio [aOR] 1.59, p = 0.036), extended LOS (aOR 2.17, p = 0.001), nonroutine discharge (aOR 1.99, p = 0.001), and 30-day mortality (aOR 2.28, p = 0.013). Malnourished status was independently associated with nonroutine discharge (aOR 1.84, p = 0.005). 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引用次数: 0
摘要
目的:老年人营养风险指数(GNRI)通常用于评估老年患者营养不良风险,但其对转移性脊柱肿瘤脊柱手术的影响尚不清楚。本研究旨在评估GNRI测量的术前营养状况与接受脊柱转移性肿瘤手术的老年患者术后发病率和死亡率之间的关系。方法:采用美国外科医师学会2011-2022年国家外科质量改进计划数据库进行回顾性队列研究。老年人(≥65岁)因硬脊膜外肿瘤转移而行椎板切除术或椎体切除术的患者使用《国际疾病分类》第9版和第10版以及现行程序术语代码进行鉴定。排除性别、术前白蛋白、身高或体重资料缺失的患者。研究人群按GNRI评分分类:正常、营养不良或严重营养不良。采用受试者工作特征(ROC)和多变量分析,作者比较了GNRI、5项修正虚弱指数(mFI-5)和年龄较大的患者与任何不良事件(AE)、延长住院时间(LOS)、非常规出院和30天死亡率的判别阈值和独立关联。结果:659例患者中,营养状况正常者277例(42.0%),营养不良者163例(24.7%),严重营养不良者219例(33.2%)。严重营养不良组电解质异常(p = 0.019)和贫血(p < 0.001)的比例显著增加,各组的BMI和白蛋白水平显著降低(p < 0.001)。营养不良和严重营养不良患者的LOS(分别为9.1±6.2天和12.5±8.6天,而正常患者为8.6±7.1天,p < 0.001)和非常规出院患者的LOS(分别为57.9%和66.7%,而正常患者为39.7%,p < 0.001)均明显延长。严重营养不良组30天死亡率显著增加(17.4% vs 6.5%,营养不良组13.5%,p = 0.001)。在多变量分析中,严重营养不良状况与AE(校正优势比[aOR] 1.59, p = 0.036)、延长的LOS (aOR 2.17, p = 0.001)、非常规出院(aOR 1.99, p = 0.001)和30天死亡率(aOR 2.28, p = 0.013)独立相关。营养不良状况与非常规出院独立相关(aOR 1.84, p = 0.005)。在ROC分析中,GNRI在预测30天ae、延长LOS、非常规出院和30天死亡率方面优于mFI-5(分别为p = 0.318、p = 0.031、p < 0.009和p = 0.026)和患者年龄(分别为p = 0.018、p < 0.001、p = 0.014和p = 0.034)。结论:本研究表明,术前gnri定义的营养不良与接受脊柱转移性肿瘤手术的老年患者术后不良预后的高风险相关。
Impact of preoperative nutritional status on morbidity and mortality in elderly patients undergoing spine surgery for metastatic spinal tumors: a role for the Geriatric Nutritional Risk Index.
Objective: The Geriatric Nutritional Risk Index (GNRI) is commonly used to assess malnutrition risk in elderly patients, but its impact on spine surgery for metastatic spinal tumors is not well understood. This study aimed to evaluate the associations between preoperative nutritional status, as measured by the GNRI, and postoperative morbidity and mortality in elderly patients undergoing spine surgery for metastatic spinal tumors.
Methods: A retrospective cohort study was performed using the 2011-2022 National Surgical Quality Improvement Program database of the American College of Surgeons. Elderly (≥ 65 years of age) patients undergoing laminectomy or corpectomy for extradural spinal tumor metastases were identified using International Classification of Diseases, 9th and 10th Revision and Current Procedural Terminology codes. Patients with missing data on sex, preoperative albumin, height, or weight were excluded. The study population was categorized by GNRI score: normal, malnourished, or severely malnourished. Using receiver operating characteristic (ROC) and multivariable analyses, the authors compared the discriminative thresholds and independent associations of GNRI, the 5-item modified frailty index (mFI-5), and older patient age with any adverse event (AE), extended hospital length of stay (LOS), nonroutine discharge, and 30-day mortality.
Results: Of the 659 patients identified, 277 (42.0%) had normal nutritional status, 163 (24.7%) were malnourished, and 219 (33.2%) were severely malnourished. The severely malnourished cohort had significantly increased proportions of electrolyte abnormalities (p = 0.019) and anemia (p < 0.001), with a significant decrease in BMI and albumin levels across cohorts (p < 0.001). Malnourished and severely malnourished patients had significantly longer LOS (9.1 ± 6.2 days and 12.5 ± 8.6 days, respectively, vs 8.6 ± 7.1 days for patients categorized as normal, p < 0.001) and nonroutine discharge (57.9% and 66.7%, respectively, vs 39.7% for normal, p < 0.001). The severely malnourished cohort had significantly increased 30-day mortality (17.4% vs 6.5% for normal and 13.5% for malnourished, p = 0.001). On multivariable analysis, severely malnourished status was independently associated with any AE (adjusted odds ratio [aOR] 1.59, p = 0.036), extended LOS (aOR 2.17, p = 0.001), nonroutine discharge (aOR 1.99, p = 0.001), and 30-day mortality (aOR 2.28, p = 0.013). Malnourished status was independently associated with nonroutine discharge (aOR 1.84, p = 0.005). In ROC analysis, GNRI outperformed the mFI-5 (p = 0.318, p = 0.031, p < 0.009, and p = 0.026, respectively) and patient age (p = 0.018, p < 0.001, p = 0.014, and p = 0.034, respectively) in predicting 30-day AEs, extended LOS, nonroutine discharge, and 30-day mortality.
Conclusions: This study suggests that preoperative GNRI-defined malnutrition is associated with a higher risk of adverse postoperative outcomes in elderly patients undergoing spine surgery for metastatic spinal tumors.
期刊介绍:
Primarily publish original works in neurosurgery but also include studies in clinical neurophysiology, organic neurology, ophthalmology, radiology, pathology, and molecular biology.