Association of malnutrition with surgical outcomes after spine surgery for spinal epidural abscess

Background: Malnutrition is a predictor of poor surgical outcomes, but its specific effects in spinal epidural abscess (SEA) are understudied. This study aims to assess the association between nutritional status and post-operative outcomes. Methods: We conducted a retrospective cohort study using the 2011-2022 American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database to identify adult SEA patients who underwent spinal surgery. The study population was divided into two groups: Nourished (preoperative serum albumin values >= 3.5 g/dL) and Malnourished (preoperative serum albumin values < 3.5 g/dL). Multivariable logistic regression analyses were performed to identify factors associated with extended length of stay (LOS), adverse events (AEs), non-routine discharge (NRD), 30-day unplanned reoperation, and mortality. Results: 1462 patients were identified and stratified by nutrition status: 300 Nourished (20.5 %) and 1162 Malnourished (79.5 %). Patients in the Malnourished cohort had a significantly higher incidence of severe medical AEs (Nourished: 42.7 % vs. Malnourished: 55.9, p < 0.001). The Malnourished cohort also had significantly increased LOS (Nourished: 11.0 +/- 7.4 days vs. Malnourished: 16.0 +/- 11.8 days, p< 0.001), NRD (Nourished: 50.3 % vs. Malnourished: 72.5%, p < 0.001), 30-day mortality (Nourished: 2.0% vs. Malnourished: 4.8 %, p = 0.031), and 30-day reoperation (Nourished: 9.3 % vs. Malnourished: 16.5 %, p = 0.002). On multivariable analysis, malnourishment was an independent predictor of extended LOS [OR: 2.47 (CI: 1.65-3.71), p< 0.001], AEs [OR: 1.41 (CI: 1.08-1.83), p = 0.011], and NRD [OR: 1.93 (CI: 1.44-2.58), p < 0.001], but not 30-day unplanned reoperation or mortality. Conclusion: Our study suggests that malnourishment may be associated with worse post-surgical outcomes for SEA patients.