The impact of preoperative nutritional status on 30-day outcomes after elective lumbar laminectomy for lumbar stenosis: a population-based cohort analysis

STUDY DESIGN: Retrospective cohort study. PURPOSE: To compare rates of 30-day reoperation (RTOR), readmission, overall postoperative complication, non-home discharge, and length of stay (LOS); and investigate individual postoperative complication rates among patients with preoperative normoalbuminemia versus hypoalbuminemia. OVERVIEW OF LITERATURE: Evidence continues to accumulate associating poor preoperative nutritional status with inferior surgical outcomes in spinal deformity and oncology. These spinal subspecialities frequently require instrumentation and significant tissue disruption. However, the relationship between preoperative nutrition and shorter, less invasive spinal decompression remains poorly assessed. METHODS: The American College of Surgeons National Surgical Quality Improvement Project database was queried to identify adult patients (>18 years) who underwent elective lumbar laminectomy for lumbar stenosis between 2015 and 2022. Univariate comparison and multivariate logistic regression analyses were conducted. RESULTS: This study identified 9,593 cases. Among primary outcomes, patients with hypoalbuminemia reported more 30-day readmission (odds ratio [OR], 1.82; 95% confidence interval [CI], 1.17-1.2.82; p =0.008) and non-home discharge rates (OR, 2.08; 95% CI, 1.57-2.76; p <0.001) as well as longer LOS (3.7±4.5 days vs. 1.9±2.4 days, p <0.0005) in both univariate and multivariate analyses, whereas they demonstrated higher RTOR (5.3% vs. 2.7%, p =0.003) and postoperative complication rates (19.0% vs. 5.8%, p <0.001) in only univariate analysis compared with those having normoalbuminemia. Among secondary outcomes, patients with hypoalbuminemia reported statistically more wound and pulmonary complications in univariate analysis; however, they had higher risks of only venous thrombosis requiring anticoagulation and stroke in multivariate analysis. CONCLUSIONS: Preoperative hypoalbuminemia is associated with higher rates of 30-day readmission, non-home discharge, and postoperative complications, as well as longer LOS after elective open lumbar laminectomy. These data indicate the importance of preoperative nutritional optimization even in shorter, more routine spinal surgery.