Nutritional status is associated with inferior clinical outcomes: A National Surgical Quality Improvement Project analysis of surgically treated spinal vascular lesions.

Background: Spinal arteriovenous shunts (sAVSs) consist of direct arterial-venous connections without intervening capillaries. Although rare, if left untreated, permanent neurological injury can occur. The present study aims to assess preoperative risks associated with 30-day unplanned readmission, 30-day unplanned reoperation (RTOR), nonhome discharge, and postoperative complications.

Methods: The American College of Surgeons National Surgical Quality Improvement Project database was employed to isolate cases of surgically treated sAVSs from 2012 to 2022. Univariate comparisons and multivariate logistic regression analyses were performed.

Results: Among the cohort, there were 18 (5.0%) 30-day readmissions, 18 (5.0%) RTOR, 145 (40.0%) nonhome discharges, and 52 (14.0%) cases with a postoperative complication. Preoperative hypoalbuminemia was a risk for 30-day readmission (P = 0.03), nonhome discharge (P < 0.001), and postoperative complications (P = 0.003) in univariate testing, while normoalbuminemia decreased the odds of nonhome discharge in multivariate analysis (OR = 0.2 [0.05-0.89], P = 0.03). Postoperative complications were associated with RTOR in both univariate and multivariate analyses (OR = 5.1 [1.44-17.94], P = 0.01). 30-day readmissions (72.2%, P = 0.008), RTOR (70.6%, P = 0.01), postoperative complications (63.5%, P < 0.001), and lower preoperative hematocrit (P = 0.004) resulted in more nonhome discharges in univariate analyses, while thoracic (odds ratio [OR] = 15.2 [1.08-213.74], P = 0.04) and thoracolumbar (OR = 20.9 [1.32-330.05], P = 0.03) sAVS and preoperative steroid use (OR = 11.1 [1.19-103.73], P = 0.04) increased the odds of postoperative complications in multivariate analysis.

Conclusion: Preoperative hypoalbuminemia increases the odds of 30-day readmissions, nonhome discharges, and postoperative complications, stressing the importance of preoperative optimization. 30-day readmission and RTOR are associated with increased rates of postoperative complications, while 30-day readmissions, RTOR, and postoperative complications resulted in more nonhome discharges.