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. 2023 Dec 26;17(6):866-874.
doi: 10.14444/8551.

Use of the Geriatric Nutritional Risk Index to Assess Risk for Postoperative Complications Following Posterior Cervical Decompression/Fusion

Dhruv Mendiratta  1 , Ashok Para  2 , Ari R Berg  2 , Michael J Vives  2
Affiliations

Use of the Geriatric Nutritional Risk Index to Assess Risk for Postoperative Complications Following Posterior Cervical Decompression/Fusion

Dhruv Mendiratta et al. Int J Spine Surg. .

Abstract

Background: Posterior cervical decompression with or without fusion (PCD/F) is used to manage degenerative spinal conditions. Malnutrition has been implicated for poor outcomes in spine surgery. The aim of this study was to assess the ability of the Geriatric Nutritional Risk Index (GNRI) as a risk calculator for postoperative complications in patients undergoing PCD/F.

Methods: The 2006 to 2018 American College of Surgeons National Surgery Quality Improvement Program Database was queried for patients undergoing PCD/F. Nutritional status was categorized as normal (GNRI greater than 98), moderately malnourished (GNRI 92-98), or severely malnourished (GNRI less than or equal to 92). Complications within 30 days of surgery were compared among the groups. Preoperative data that were statistically significant (P < 0.05) upon univariate χ2 analysis were included in the univariate then multivariate binary regression model to calculate adjusted ORs. All ORs were assessed at the 95% CI.

Results: Of the 7597 PCD/F patients identified, 15.6% were severely malnourished and 19.1% were moderately malnourished. Severe and moderate malnourishment were independent risk factors for mortality (OR = 3.790, 95% CI 2.492-5.763, P < 0.001; OR = 2.150, 95% CI 1.351-3.421, P = 0.011). Severe malnourishment was an independent risk factor for sepsis/septic shock (OR = 3.448, 95% CI 2.402-4.948, P < 0.001).

Conclusions: In elderly patients undergoing PCD/F, severe malnutrition, as defined by the GNRI, was an independent risk factor for mortality and sepsis/septic shock.

Clinical relevance: The GNRI may be more useful than other indices for risk stratification in elderly patients because it accounts for confounding variables such as hydration status and paradoxical malnourishment in obese patients.

Keywords: NSQIP; geriatric nutritional risk index (GNRI); malnutrition; posterior cervical decompression and fusion (PCD/F); spinal fusion.

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Conflict of interest statement

Declaration of Conflicting Interests : The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Adjusted odds ratios of mortality for selected preoperative risk factors. Age is given in years. COPD, chronic obstructive pulmonary disease.
Figure 2
Figure 2
Adjusted odds ratio of sepsis/septic shock for selected preoperative risk factors. Age is given in years. COPD, chronic obstructive pulmonary disease.
Figure 3
Figure 3
Adjusted odds ratios of surgical site infection for selected preoperative risk factors. COPD, chronic obstructive pulmonary disease.
See this image and copyright information in PMC

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