Preoperative CONUT Score Stratifies Risk of Readmission After Posterior Cervical Decompression and Fusion.

STUDY

DESIGN

Retrospective Cohort Study.

OBJECTIVE

This study aimed to compare postoperative outcomes between patients of varying nutritional deficiency status as measured by the CONUT score undergoing posterior cervical decompression and fusion (PCDF).

SUMMARY OF BACKGROUND DATA: Malnutrition is an established risk factor for poor postoperative outcomes. The COntrolling NUTritional status (CONUT) score has emerged as a novel method of assessing a patient's nutritional status.

METHODS

Adult patients undergoing primary, elective PCDF (2017-2023) were identified. Patients were included if they had components of the CONUT score, specifically deficiencies in serum albumin, total cholesterol, or lymphocyte counts, within 6 months preoperatively. Data regarding modified 5-item frailty index, demographic/surgical variables, and postoperative outcomes were collected.

RESULTS

206 patients were included and stratified into normal nutritional status, mild nutritional deficiency, and moderate/severe nutritional deficiency. Age, Charlson Comorbidity Index (CCI), and Distressed Community Index differed between cohorts. Length of stay (LOS) correlated with CONUT score (normal: 4.77, mild: 6.20, moderate/severe: 10.0 days; P=0.001). Frequency of inpatient complications (normal: 8.7%, mild: 11.8%, moderate/severe: 33.3%; P=0.017), discharge to home (normal: 84.8%, mild: 82.8%, moderate/severe: 38.1%; P<0.001), and 31-90 day readmissions (normal: 6.52%, mild: 7.53%, moderate/severe: 38.1%; P=0.001) differed between cohorts. Proportion of frail patients (normal: 79.3%, mild: 86.0%, moderate/severe: 100%; P=0.041) and frailty scores (normal: 1.28, mild: 1.70, moderate/severe: 2.38; P<0.001) differed between cohorts. A multivariable regression controlling for CONUT nutritional status, frailty score, CCI Age score, DCI, and discharge to SNF found that only moderate/severe nutritional deficiency was associated with 90-day readmissions (OR: 4.99, 95% CI: 1.40-18.75; P=0.014).

DISCUSSION: In patients undergoing PCDF, moderate/severe nutritional deficiency was associated with 90-day readmissions independent of comorbidity burden and frailty score. Thus, further investigation of optimizing nutritional status prior to PCDF may be warranted to minimize postoperative healthcare utilization.