Preoperative Serum Albumin and TLC as Predictors of Postoperative Complications in Spine Surgery

Study Design: Narrative review. Purpose: To investigate the state of literature regarding serum albumin and total lymphocyte count and their associations with postoperative complications after spine surgery. Methods: Comprehensive search of the PubMed database was performed to find relevant articles addressing preoperative serum albumin, total lymphocyte count, or their respective composite scores and their associations with postoperative complications after spine surgery. Summary of Background Data: Serum albumin level is frequently cited as a marker of patient nutritional status. Total lymphocyte count has more recently gained attention in the literature for similar reasons. Identification of modifiable preoperative patient risk factors for postoperative complications such as malnutrition may help minimize the incidence of postoperative complications. Results: Review of the literature revealed 10 studies that discussed the association between preoperative hypoalbuminemia and postoperative complications. Five studies examined the relationship between either prognostic nutritional index (PNI), controlling nutritional status (CONUT), or both and postoperative complications after spine surgery. Preoperative hypoalbuminemia, low PNI, and high CONUT scores were associated with increased risk of postoperative complications after spine surgery. Conclusions: Preoperative malnourishment is a modifiable patient factor that is associated with an increased risk of postoperative complications after spine surgery.