Malnutrition is a risk factor for adult spinal deformity (ASD) patients, researchers say. But nutritional intervention before surgery may reduce postoperative complications and slow down nutritional deterioration.
Adult Spinal Deformity May Contribute to Malnutrition
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The researchers published their findings in “The Effect of Preoperative Nutritional Intervention for Adult Spinal Deformity Patients” in the March 2022 issue of SPINE.
In this prospective nutritional intervention study, the research team wanted to investigate how a nutritional intervention would affect the incidence of postoperative medical complications and nutritional status.
“The medical complication rate in adult spinal deformity surgery is very high, and one risk factor is malnutrition. Nutritional intervention may improve the patient’s nutritional status and reduce risk, but this is unexplored regarding adult spinal deformity surgery,” the researchers wrote.
For the study, malnourished patients were divided into two groups. Group I received nutritional intervention consisting of nutritional guidance and supplements on the day of surgery while the patients in Group NI had no nutritional intervention before surgery. Malnourishment was defined as a prognostic nutritional index score of less than 5.
The surgeries in Group I took place after November 2018 while the surgeries in Group NI were performed between January 2014 and October 2018.
Group I had 24 patients with the mean age of 70 years while Group NI had 69 patients with a mean age of 68 years. The mean intervention duration was 41 days.
In addition, the nutritional status was compared between Group I and Group NI2—patients who didn’t participate in nutritional intervention after November 2018. Group NI2 included 61 patients with the mean age of 68 years.
Overall, the preoperative prognostic nutritional index (PNI) score did not differ between the two groups, but Group NI did have significantly more medical complication incidences (Group I: 25%; Group NI: 53.6%; p = 0.015).
The researchers found that nutritional status significantly deteriorated in Group I (PNI: 47-45; p = 0.011) and Group NI2 (PNI: 52-48; p = 0.000), but the PNI changes were significantly smaller in Group I.
“Nutritional intervention with guidance and supplements reduced postoperative medical complications in malnourished patients. The nutritional status of adult spinal deformity patients requiring surgery also naturally worsened, suggesting that ASD may contribute to malnutrition. Nutritional intervention may reduce the nutritional status deterioration,” they wrote.
Study authors included Sin Oe, M.D., Jun Watanabe, Tatsuya Akai, Tomomi Makino, Midori Ito, Yu Yamato, M.D., Tomohiko Hasegawa, M.D., Go Yoshida, M.D., Tomohiro Banno, M.D., Hideyuki Arima, M.D., Yuki Mihara, M.D., Hiroki Ushirozako, M.D., Tomohiro Yamada, M.D., Koichiro Ide, M.D., Yuh Watanabe, M.D., Kenta Kurosu, M.D., Keiichi Nakai, M.D., and Yukihiro Matsuyama, M.D., all of the Hamamatsu University School of Medicine in Hamamatsu, Japan.
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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