Albumin Levels Stratify Risk of 30-Day Complications Following Posterior Cervical Fusion.

Area of Science:

• Neurosurgery
• Orthopedic Surgery
• Clinical Chemistry

Background:

• Posterior cervical fusion (PCF) rates have increased, with complications in up to 25% of cases.
• Hypoalbuminemia is a potential risk factor for post-spine surgery complications, but precise thresholds are undefined.
• Limited literature exists on preoperative albumin's impact on PCF outcomes.

Purpose of the Study:

• To establish data-driven preoperative albumin thresholds for risk stratification of 30-day complications after PCF.
• To identify specific albumin levels associated with increased complication risk following PCF.

Main Methods:

• Retrospective cohort study using a national database of patients undergoing PCF.
• Stratum-specific likelihood ratio (SSLR) analysis to determine albumin thresholds.
• Multivariable regression to assess the risk of 30-day major and minor complications.

Main Results:

• Three preoperative albumin strata were identified: 1-3.2 g/dL, 3.2-3.6 g/dL, and 3.6+ g/dL.
• Compared to the 3.6+ g/dL group, the 1-3.2 g/dL (OR: 3.02) and 3.2-3.6 g/dL (OR: 1.65) groups had significantly higher odds of 30-day complications.
• A clear, dose-dependent relationship exists between lower albumin levels and increased complication risk.

Conclusions:

• Data-driven preoperative albumin thresholds can effectively stratify 30-day complication risk after PCF.
• This is the first study to demonstrate the variable and stratifiable risk associated with preoperative albumin levels in PCF.
• Findings support using albumin levels for informed surgical decision-making and improved patient outcomes.