Understanding Perioperative Nutrition in Patients Undergoing Spine Surgery

The consequences of malnutrition in spine surgery have been studied to a lesser degree compared to other orthopedic subspecialties. However, there is growing interest in understanding the effects of preoperative malnutrition on spine surgery outcomes. Literature on the relationship between malnutrition and spine surgery outcomes appeared sporadically in the late 1990s and early 2000s. Over the last decade, however, there has been a push to understand the sequelae of malnutrition on patients undergoing spine surgery. The aims of this review are to highlight: 1. the different parameters by which malnutrition has been defined and measured in spine surgery; 2. the prevalence of malnutrition in spine surgery; 3. the outcomes of spine surgery in malnourished patients; and 4. the effects of nutritional supplementation or interventions on spine surgery outcomes. Malnutrition has often been defined utilizing specific serological laboratory values or nutritional indices. Serologic values of malnutrition include an albumin < 3.5 g/dL, transferrin < 150 mg/ dL, or a total lymphocyte count of < 1,500 cells/mm3 . The available literature reports that the prevalence of malnutrition in patients undergoing lumbar spine surgery ranges from 5% to 50%, with most literature supporting a value toward the higher end of this spectrum. Malnourished patients undergoing spine surgery have higher rates of surgical site infections, medical complications, lengths of stay, ICU admissions, 30-day and 1-year mortalities, reoperations, 30-day readmissions, and costs of care. Given the plethora of spine surgeries performed in the country annually and the prevalence of malnutrition in up to 50% of our patients, we recommend performing preoperative nutritional assessments on all patients to ensure their optimization prior to surgery.