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Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines for Perioperative Spine: Preoperative Nutritional Assessment. Neurosurgery 2021 Oct 13;89(Suppl 1):S26-S32



Pubmed ID




Scopus ID

2-s2.0-85118598092 (requires institutional sign-in at Scopus site)   6 Citations


BACKGROUND: Preoperative malnutrition has been implicated in adverse events after elective surgery, potentially impacting patient outcomes.

OBJECTIVE: As a potentially modifiable risk factor, we sought to determine which assessments of nutritional status were associated with specific adverse events after spine surgery. In addition, we explored if a preoperative nutritional improvement intervention may be beneficial in lowering the rates of these adverse events.

METHODS: The literature search yielded 115 abstracts relevant to the PICO (patient/population, intervention, comparison, and outcomes) questions included in this chapter. The task force selected 105 articles for full text review, and 13 met criteria for inclusion in this systematic review.

RESULTS: Malnutrition, assessed preoperatively by a serum albumin <3.5 g/dL or a serum prealbumin <20 mg/dL, is associated with a higher rate of surgical site infections (SSIs), other wound complications, nonunions, hospital readmissions, and other medical complications after spine surgery. A multimodal nutrition management protocol decreases albumin and electrolyte deficiencies in patients with normal preoperative nutritional status. It also improves overall complication rates but does not specifically impact SSIs.

CONCLUSION: It is recommended to assess nutritional status using either serum albumin or prealbumin preoperatively in patients undergoing spine surgery.The full guidelines can be accessed at

Author List

Bisson EF, Dimar J, Harrop JS, Hoh DJ, Mohamed B, Mummaneni PV, Wang MC, Dhall S


Marjorie Wang MD Chief, Professor in the Neurosurgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Elective Surgical Procedures
Nutrition Assessment
Retrospective Studies