The Predictive Potential of Nutritional and Metabolic Burden

Retrospective cohort review.To develop a scoring system for predicting increased risk of post-operative complications in ASD surgery based on baseline nutritional and metabolic factors.Endocrine and metabolic conditions have been shown to adversely influence patient outcomes, and may increase the likelihood of post-operative complications. The impact of these conditions has not been effectively evaluated in patients undergoing adult spinal deformity (ASD) surgery.ASD patients ≥ 18 years with baseline (BL) and two-year (2Y) data were included. An internally cross-validated weighted equation using pre-operative laboratory and comorbidity data correlating to increased peri-operative complications was developed via Poisson regression. BMI categorization (normal, over/underweight, obese) and diabetes classification (normal, prediabetic, diabetic) were used per CDC and ADA parameters. A novel spine-specific metabolic burden score (ASD-NMBS) was calculated via Beta-Sullivan adjustment, and Conditional Inference Tree (CIT) determined score threshold for experiencing ≥1 complication. Cohorts were stratified into LOW and HIGH risk groups for comparison. Logistic regression assessed correlations between increasing burden score and complications.201 ASD patients were included (mean age: 58.60±15.4, sex: 48% female, BMI: 29.95±14.31, CCI: 3.75± 2.40). Significant factors were determined to be: age (+1/year), hypertension (+18), peripheral vascular disease (+37), smoking status (+21), anemia (+1), VitD hydroxyl (+1 per ng/mL), BMI (+13/cat), and diabetes (+4/cat) (model: P <.001, AUC: 92.9%). CIT determined scores above 175 correlated with ≥ 1 post-op complication ( P <.001). Furthermore, HIGH patients reported higher rates of post-operative cardiac complications ( P =.045), and were more likely to require reoperation ( P =.024) compared to LOW patients.Development of a validated novel nutritional and metabolic burden score (ASD-NMBS) demonstrated that patients with higher scores are at greater risk of increased post-operative complications and course. As such, surgeons should consider reduction of nutritional and metabolic burden pre-operatively to enhance outcomes and reduce complications in ASD patients.