Comparison of 30-day surgical outcomes of multi-level sub-axial anterior (ACDF) vs posterior (PCDF) approach to cervical decompression and fusion in the setting of pre-operative malnutrition.

Evidence continues to mount supporting the detrimental effects malnutrition has on spine surgery outcomes. However, improving nutrition with cervical pathology faces challenges, such as progressive neurological decline with surgical delays, which may force intervention despite patient malnutrition. The American College of Surgeons National Surgical Quality Improvement Project (NSQIP) database was queried to identify adult patients who underwent multi-level sub-axial anterior cervical discectomy and fusion (ACDF) or posterior cervical decompression and fusion (PCDF) from 2015 to 2022 in the setting of pre-operative malnutrition defined by hypoalbuminemia. Univariate and multivariate analyses were performed. In univariate analysis, PCDF had significantly higher rates of post-operative complications (32.3 % vs 20.4 %, p < 0.001), non-home discharges (71.3 % vs 43.7 %, p < 0.001), superficial surgical site infections (1.4 % vs 0.0 %, p = 0.007), urinary tract infections (5.9 % vs 2.9 %, p = 0.02) and blood transfusions (12.8 % vs 5.3 %, p < 0.001) as well as longer LOS (7.9 ± 6.2 vs 5.1 ± 5.8 days, p < 0.0005) compared to ACDF. When controlling for confounding variables, including levels of instrumentation and baseline characteristics, via multivariate analysis, all significance was lost. 30-day readmissions, RTOR and 30-day mortality did not differ between groups. Overall, short term surgical outcomes of ACDF vs PCDF in adult patients with malnutrition are similar. Surgical approach should be guided by surgeon judgement and be tailored to individual patient needs. Data on long term outcomes within this population is needed.