Volume 57, May–June 2024, Pages 103-108Author links open overlay panel, , Highlights•

Older patients at high nutritional risk face increased adverse postoperative outcomes.

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The GNRI aids nurses in identifying high-risk older patients.

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GNRI assessment is important for addressing nutritional needs and improving outcomes.

AbstractAim

To examine whether a high nutritional risk status, assessed via the Geriatric Nutritional Risk Index (GNRI), is independently associated with postoperative health outcomes, including unplanned intensive care unit (ICU) admissions, infectious complications, and prolonged length of stay in older patients undergoing spine surgery.

Methods

We conducted a retrospective descriptive study analyzing electronic health records from a tertiary hospital, including data from 1,014 patients aged ≥70 undergoing elective spine surgery between February 2013 and March 2023.

Results

High nutritional risk patients had significantly higher odds of unplanned ICU admission, infectious complications, and prolonged length of stay compared to low-risk patients. For each one-point increase in GNRI, there was a significant 0.91- and 0.95-fold decrease in the odds of unplanned ICU admission and infectious complications, respectively.

Conclusion

GNRI screening in older patients before spine surgery may have potential to identify those at elevated risk for postoperative adverse outcomes.

Section snippetsBackground

The prevalence of spine surgery among older adults is on a steady incline, a trend gaining prominence globally. In South Korea, there was a notable increase of 62.6 % in spine surgeries for patients aged ≥65 years between 2006 and 2018.1 Similarly, in the United States, there was a 73 % increase in lumbar spinal fusion procedures within the same age group between 2004 and 2015.2 As the global population continues to age, the demand for spine surgery in older adults is expected to increase

Study design and setting

This study was employed a retrospective observational design. We extracted patients’ electronic health records data from the medical records of clinical data repository system, SCRAP (Severance Clinical Research Analysis Portal), at Yonsei University Severance Hospital, excluding any identifiable information. Ethical approval was obtained from the Institutional Review Board of Yonsei University Healthcare System (IRB no. 4–2023–0262). Due to the retrospective observational nature of the study

Demographic and clinical characteristics

The demographic and clinical characteristics are described in Table 1. Patients had an average age of 75.4 years (SD: 4.2), with 56.3 % females. Over half underwent spinal fusion or fixation (57.6 %). Regarding postoperative health outcomes, 10.1 % were admitted to the ICU within 7 days postoperatively, and 4.4 % had infectious complications. Approximately 21 % stayed ≥11 days postoperatively (median: 7 days, IQR: 5–10 days). Among the 45 patients with infectious complications, eight had UTIs,

Discussion

In the current study, we evaluated the association between preoperative nutritional status, evaluated using the GNRI, and postoperative health outcomes, including unplanned ICU admission, infectious complications, and prolonged length of stay, in older patients undergoing spine surgery. A notable strength of this study is the comprehensive consideration of various perioperative characteristics, including laboratory test results and intraoperative features obtained from electronic health

Conclusion

This retrospective observational study utilizing electronic health records observed a significant association between a high preoperative nutritional risk, screened using the GNRI, and increased rates of infectious complications, unplanned ICU admission, and prolonged length of stay. Screening patients using the GNRI may hold potential to effectively identify older patients at elevated risk for postoperative adverse outcomes. Future multicenter studies, with consideration of additional

Data availability

The data that support the findings of this study are available on request from the corresponding author upon reasonable request.

Ethical considerations

The study received approval from the Institutional Review Board of Yonsei University Health System in Seoul, South Korea (IRB no. 4–2023–0262).

CRediT authorship contribution statement

Hyeonmi Cho: Writing – review & editing, Writing – original draft, Formal analysis, Conceptualization. Jeongeun Choi: Writing – review & editing, Writing – original draft, Data curation. Hyangkyu Lee: Writing – review & editing, Writing – original draft, Methodology, Conceptualization.

Declaration of competing interest

The authors declare that there are no conflicts of interest.

Funding

This study was supported by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education (No. 2020R1A6A1A03041989).

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