Data-driven Preoperative Albumin Level Predicts Increased Risk of 30-day Surgical Site Infection Following Anterior Cervical Discectomy and Fusion.

Introduction: Postoperative infection remains a significant concern and technical challenge for spine surgeons. Preoperative albumin level may predict risk of infection, but no definitive consensus regarding the optimal preoperative albumin level in anterior cervical discectomy and fusion (ACDF) has been reached. Therefore, this study aimed (1) to determine the impact of preoperative albumin on complications following ACDF and (2) to identify optimal albumin threshold that minimizes the likelihood of infection following ACDF.

Methods: A retrospective cohort analysis was performed using a national database. Patients with a preoperative measurement of albumin prior to ACDF were included, whereas patients undergoing multilevel ACDF were excluded. Stratum-specific likelihood ratio (SSLR) analysis was conducted to determine data-driven albumin strata that minimized the likelihood of infectious complications within 30 days of ACDF.

Results: A total of 30,896 ACDF patients were included in this study. Stratum-specific likelihood ratio analysis identified two albumin strata: 1-3 and 3+ g/dL prior to surgery. Relative to the 3+ g/dL cohort, the 1-3 g/dL cohort was more likely to experience 30-day infectious complications such as deep surgical site infection (SSI) (OR: 8.02, P<0.001) and SSI domain (OR: 4.85, P<0.001).

Conclusions: This study demonstrates a significant association between preoperative albumin level and infectious complications following ACDF. These results emphasize the importance of integrating nutritional management strategies into the broader context of surgical decision-making, thus contributing to enhanced patient outcomes and quality of care in spine surgery.