DOI: 10.1097/bn9.0000000000000128 ISSN: 3066-8905

Preoperative Nutrition Screening Predicts 90-Day Surgical Site Infections in Elective Spine Surgery: A Retrospective Cohort Study

Phillip Alexeev, Neeku Misaghian, Pitcherita Anthenor, Molly Szpakowski, Joshua Jimenez, Chance Swanson, Ryan Snowden
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Study Design:

A retrospective cohort study.

Objective:

To determine whether preoperative nutritional status, measured by the Mini Nutritional Assessment–Short Form (MNA-SF), is independently associated with 90-day surgical site infection (SSI) after elective spinal fusion.

Summary of Background Data:

SSI remains a significant complication after elective spinal fusion. Although nutritional screening is increasingly used preoperatively, its independent relationship with SSI risk in spine surgery remains unclear.

Materials and Methods:

We retrospectively reviewed 756 adults who underwent elective spinal fusion at a tertiary center from 2024 to 2025, excluding patients with oncology diagnoses. Demographic, clinical, and perioperative variables were collected, including MNA-SF category (well-nourished vs . at risk/malnourished), administered on the day of surgery. Univariate analyses compared patients with and without SSI. Multivariable logistic regression identified independent predictors of SSI, with variables selected a priori based on clinical relevance.

Results:

Among 756 patients (mean age 61±13.4 yr), 37 (4.9%) developed SSI within 90 days. Patients with SSI had higher body mass index (33.6 vs . 30.9 kg/m², P =0.023), longer operative duration (266.2 vs . 196.7 min, P =0.001), higher rates of nutritional vulnerability by MNA-SF (51.4% vs . 27.1%, P =0.003), and more frequent prior surgical infection (13.5% vs . 3.3%, P =0.007). On multivariable analysis, higher BMI (OR: 1.064, P =0.007), longer operative duration (OR: 1.004/min, P =0.014), lower preoperative hemoglobin (OR: 0.726, P =0.005), prior infection (OR: 3.400, P =0.031), and nutritional status remained independently associated with SSI. Well-nourished patients had lower odds of SSI than those at risk/malnourished (OR: 0.464, P =0.039).

Conclusion:

Preoperative nutritional vulnerability was independently associated with increased 90-day SSI risk after elective spinal fusion. Functional nutritional screening may improve preoperative risk stratification and support targeted optimization strategies.

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