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Preoperative geriatric nutritional risk index is useful factor for predicting postoperative delirium among elderly patients with degenerative lumbar diseases

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Abstract

Purpose

It is the first study to evaluate the predictive value of the geriatric nutritional risk index (GNRI) on postoperative delirium (POD) after transforaminal lumber interbody fusion (TLIF) in elderly patients with degenerative lumbar diseases.

Methods

A retrospective study was conducted to assess the outcomes of TLIF surgery in elderly patients with lumbar degenerative disease between the years 2016 and 2022. Delirium was diagnosed by reviewing postoperative medical records during hospitalization, utilizing the Confusion Assessment Method. The geriatric nutritional risk index was calculated using the baseline serum albumin level and body weight. Multivariate logistic regression analysis was employed to identify the association between preoperative GNRI and postoperative delirium (POD). Additionally, a receiver operating characteristic curve was utilized to determine the optimal GNRI cutoff for predicting POD.

Results

POD was observed in 50 of the 324 patients. The GNRI was visibly reduced in the delirium group. The mean GNRI was 93.0 ± 9.1 in non-delirium group and 101.2 ± 8.2 in delirium group. On multivariate logistic regression, Risk of POD increases significantly with low GNRI and was an independent factor in predicting POD following TLIF (OR 0.714; 95% CI 0.540–0.944; p = 0.018). On receiver operating characteristic curve, the area under curve (AUC) for GNRI was 0.738 (95% CI 0.660–0.817). The cutoff value for GNRI according to the Youden index was 96.370 (sensitivity: 66.0%, specificity: 70.4%).

Conclusion

Our study indicated that lower GNRI correlated significantly with POD after TLIF. Performing GNRI evaluation prior to TLIF may be an effective approach of predicting the risk for POD among elderly patients with degenerative lumbar diseases.

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Data availability

Data will be available by contacting Limin Liu, the corresponding author, at the above address.

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Acknowledgements

This study was supported in part by the Project funded by China Postdoctoral Science Foundation (2023M732469); Sichuan University Postdoctoral Interdisciplinary Innovation Fund (JCXK2205); Projects of the Science and Technology Department of Sichuan Province (2022ZDZX0029, MZGC20230019); the 1·3·5 project for disciplines of excellence Clinical Research Incubation Project, West China Hospital, Sichuan University (2021HXFH003); Research Projects of Affiliated Hospital of North Sichuan Medical College (2022JC020). Sichuan Science and Technology Program (2023NSFSC0659); Sichuan Provincial Medical Association Special Research Fund (2023SAT06, 2019HR18).

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Author notes

  1. Qian Chen and Ce Zhu contributed equally.

Authors and Affiliations

  1. Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China

    Qian Chen, Ce Zhu, Youwei Ai, Juehan Wang, Hong Ding, Dun Luo, Yueming Song, Ganjun Feng & Limin Liu

  2. Department of Orthopaedics and Laboratory of Biological Tissue Engineering and Digital Medicine, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China

    Qian Chen

  3. Department of Neurosurgery, Hokkaido University, Sapporo, Japan

    Zheng Li

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  1. Qian Chen
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Correspondence to Limin Liu.

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Approval obtained from Biomedical Ethics Review Committee of West China Hospital, Sichuan University (Approval number: 2023-250). The requirement for informed consent was waived to the retrospective analysis.

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Chen, Q., Zhu, C., Ai, Y. et al. Preoperative geriatric nutritional risk index is useful factor for predicting postoperative delirium among elderly patients with degenerative lumbar diseases. Eur Spine J 33, 1055–1060 (2024). https://doi.org/10.1007/s00586-024-08142-8

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  • DOI: https://doi.org/10.1007/s00586-024-08142-8

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