Impact of preoperative nutritional status on morbidity and mortality in geriatric patients undergoing spine surgery: Role of geriatric nutritional risk index

Aladine A Elsamadicy; Paul Serrato; Selma Belkasim; Shaila D Ghanekar; Justice Hansen; Syed I Khalid; Sheng-Fu Larry Lo; Daniel M Sciubba

doi:10.1016/j.clineuro.2025.109000

Impact of preoperative nutritional status on morbidity and mortality in geriatric patients undergoing spine surgery: Role of geriatric nutritional risk index

Clin Neurol Neurosurg. 2025 Jun 10:256:109000. doi: 10.1016/j.clineuro.2025.109000. Online ahead of print.

Authors

Aladine A Elsamadicy¹, Paul Serrato², Selma Belkasim², Shaila D Ghanekar², Justice Hansen², Syed I Khalid³, Sheng-Fu Larry Lo⁴, Daniel M Sciubba⁴

Affiliations

¹ Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, United States. Electronic address: aladine.elsamadicy@yale.edu.
² Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, United States.
³ Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL, United States.
⁴ Department of Neurosurgery, Zucker School of Medicine at Hofstra, Long Island Jewish Medical Center and North Shore University Hospital, Northwell Health, Manhasset, NY, United States.

PMID: 40513144
DOI: 10.1016/j.clineuro.2025.109000

Abstract

Background: Malnutrition is a risk factor for poor surgical outcomes amongst the elderly. However, the association between malnutrition and outcomes in geriatric patients undergoing spine surgery has been understudied. The aim of this study was to assess associations between malnutrition and 30-day morbidity and mortality in geriatric patients undergoing spine surgery.

Methods: A retrospective cohort study was performed using the American College of Surgeons National Surgical Quality Improvement Program database. All geriatric patients (≥ 65 years old) were categorized by Geriatric Nutritional Risk Index (GNRI) score: Normal, Malnourished, and Severely Malnourished. Patient demographics, comorbidities, and adverse events (AEs) were assessed. Multivariable logistic regression analyses identified independent predictors of 30-day postoperative AEs, extended length of stay (LOS), non-routine discharge (NRD), unplanned readmission, and mortality.

Results: Of the 79,160 patients identified, 58,906 (74.4 %) had Normal nutritional status, 12,184 (15.4 %) were Malnourished, and 8070 (10.2 %) were Severely Malnourished. The Malnourished and Severely Malnourished cohorts had significantly increased proportion of AEs (p < 0.001) and a longer LOS (p < 0.001). The Malnourished and Severely Malnourished cohorts had significantly increased proportions of NRD (p < 0.001), unplanned readmissions (p < 0.001), and 30-day mortality (p < 0.001). On multivariable analysis, Malnourished and Severely Malnourished statuses, respectively, were independently associated with any AE (p < 0.001), extended LOS (p < 0.001), 30-day unplanned readmission (p < 0.001), NRD (p < 0.001), and 30-day mortality (p < 0.001).

Conclusion: Our study suggests that preoperative GNRI-defined malnutrition may increase the risk of adverse postoperative outcomes following spine surgery in geriatric patients.

Keywords: Geriatric nutritional risk index (GNRI); Geriatric patients; Malnutrition; Morbidity; Mortality; Postoperative outcomes; Spine surgery.