The Predictive Potential of Nutritional and Metabolic Burden: Development of a Novel Validated Metric Predicting Increased Post-Operative Complications in Adult Spinal Deformity Surgery.
Journal
Spine
ISSN: 1528-1159
Titre abrégé: Spine (Phila Pa 1976)
Pays: United States
ID NLM: 7610646
Informations de publication
Date de publication:
10 Aug 2023
10 Aug 2023
Historique:
received:
27
01
2023
accepted:
29
07
2023
pubmed:
13
8
2023
medline:
13
8
2023
entrez:
13
8
2023
Statut:
aheadofprint
Résumé
Retrospective cohort review. To develop a scoring system for predicting increased risk of post-operative complications in ASD surgery based on baseline nutritional and metabolic factors. Endocrine and metabolic conditions have been shown to adversely influence patient outcomes, and may increase the likelihood of post-operative complications. The impact of these conditions has not been effectively evaluated in patients undergoing adult spinal deformity (ASD) surgery. ASD patients ≥ 18 years with baseline (BL) and two-year (2Y) data were included. An internally cross-validated weighted equation using pre-operative laboratory and comorbidity data correlating to increased peri-operative complications was developed via Poisson regression. BMI categorization (normal, over/underweight, obese) and diabetes classification (normal, prediabetic, diabetic) were used per CDC and ADA parameters. A novel spine-specific metabolic burden score (ASD-NMBS) was calculated via Beta-Sullivan adjustment, and Conditional Inference Tree (CIT) determined score threshold for experiencing ≥1 complication. Cohorts were stratified into LOW and HIGH risk groups for comparison. Logistic regression assessed correlations between increasing burden score and complications. 201 ASD patients were included (mean age: 58.60±15.4, sex: 48% female, BMI: 29.95±14.31, CCI: 3.75± 2.40). Significant factors were determined to be: age (+1/year), hypertension (+18), peripheral vascular disease (+37), smoking status (+21), anemia (+1), VitD hydroxyl (+1 per ng/mL), BMI (+13/cat), and diabetes (+4/cat) (model: P <.001, AUC: 92.9%). CIT determined scores above 175 correlated with ≥ 1 post-op complication ( P <.001). Furthermore, HIGH patients reported higher rates of post-operative cardiac complications ( P =.045), and were more likely to require reoperation ( P =.024) compared to LOW patients. Development of a validated novel nutritional and metabolic burden score (ASD-NMBS) demonstrated that patients with higher scores are at greater risk of increased post-operative complications and course. As such, surgeons should consider reduction of nutritional and metabolic burden pre-operatively to enhance outcomes and reduce complications in ASD patients.
Sections du résumé
STUDY DESIGN
METHODS
Retrospective cohort review.
OBJECTIVE
OBJECTIVE
To develop a scoring system for predicting increased risk of post-operative complications in ASD surgery based on baseline nutritional and metabolic factors.
BACKGROUND
BACKGROUND
Endocrine and metabolic conditions have been shown to adversely influence patient outcomes, and may increase the likelihood of post-operative complications. The impact of these conditions has not been effectively evaluated in patients undergoing adult spinal deformity (ASD) surgery.
METHODS
METHODS
ASD patients ≥ 18 years with baseline (BL) and two-year (2Y) data were included. An internally cross-validated weighted equation using pre-operative laboratory and comorbidity data correlating to increased peri-operative complications was developed via Poisson regression. BMI categorization (normal, over/underweight, obese) and diabetes classification (normal, prediabetic, diabetic) were used per CDC and ADA parameters. A novel spine-specific metabolic burden score (ASD-NMBS) was calculated via Beta-Sullivan adjustment, and Conditional Inference Tree (CIT) determined score threshold for experiencing ≥1 complication. Cohorts were stratified into LOW and HIGH risk groups for comparison. Logistic regression assessed correlations between increasing burden score and complications.
RESULTS
RESULTS
201 ASD patients were included (mean age: 58.60±15.4, sex: 48% female, BMI: 29.95±14.31, CCI: 3.75± 2.40). Significant factors were determined to be: age (+1/year), hypertension (+18), peripheral vascular disease (+37), smoking status (+21), anemia (+1), VitD hydroxyl (+1 per ng/mL), BMI (+13/cat), and diabetes (+4/cat) (model: P <.001, AUC: 92.9%). CIT determined scores above 175 correlated with ≥ 1 post-op complication ( P <.001). Furthermore, HIGH patients reported higher rates of post-operative cardiac complications ( P =.045), and were more likely to require reoperation ( P =.024) compared to LOW patients.
CONCLUSIONS
CONCLUSIONS
Development of a validated novel nutritional and metabolic burden score (ASD-NMBS) demonstrated that patients with higher scores are at greater risk of increased post-operative complications and course. As such, surgeons should consider reduction of nutritional and metabolic burden pre-operatively to enhance outcomes and reduce complications in ASD patients.
Identifiants
pubmed: 37573568
doi: 10.1097/BRS.0000000000004797
pii: 00007632-990000000-00434
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
The authors report no conflicts of interest.