Malnutrition and its Influence on Surgical Complications in Posterior Arthrodesis for Degenerative Sagittal Deformity

Introduction: There is a paucity of literature describing the effect of malnutrition, as defined by surrogate markers such as albumin < 3.5 g/dL, on surgical outcomes in patients undergoing posterior arthrodesis for degenerative sagittal deformity. We sought to elucidate this relationship.

Methods: Using the TrinetX database, we analyzed 1,716 patients diagnosed with sagittal imbalance managed operatively with posterior arthrodesis (CPT codes: 28200, 28202, and 28204) across 60 Healthcare Organizations, from 2008 to 2023). Three hundred eighty-nine patients fit criteria for malnourishment and 1327 did not. T-tests were used to compare outcome differences between groups.

Results: The incidence of any type of postoperative complication was higher in the malnourished population (18.8% vs 12.3%, p=.001). Malnourished patients were more likely to experience postoperative infection (11.3% vs 6.3%, p=.001), require hardware removal (9.3% vs. 5.8%; p=.016), higher incidence of pneumonia and sepsis (9.3% vs. 5.7%, p=.011, and 7.7% vs. 3.7%; p=.001 respectively), higher readmission rates (2.6% vs. 0.8%; p=.003), and increased postoperative mortality rates (3.1% vs 1.1%; p=.006). There was no statistically significant difference in deep vein thrombosis (DVT) (3.3% vs 2.3%, p=0.27), pulmonary embolism (PE) (3.1% vs 3.2%, p=.936), or urinary tract infections (UTI) (10% vs. 8.5%, p=.357)

Conclusion : In the setting of elective posterior arthrodesis for kyphosis management, malnourished patients are at an increased risk of postoperative complications, readmission, death, infection, and hardware removal. There was no statistically significant difference in DVT, PE, or UTIs. This data suggests perioperative nutritional optimization for patients with degenerative sagittal imbalance undergoing posterior arthrodesis may improve post-surgical outcomes and serve as a low-cost tool for preoperative optimization. Further studies with larger datasets are needed to ratify these retrospective results.