DOI: 10.1097/brs.0000000000004797 ISSN:

The Predictive Potential of Nutritional and Metabolic Burden

Peter S. Tretiakov, Zach Thomas, Oscar Krol, Rachel Joujon-Roche, Tyler Williamson, Bailey Imbo, Pooja Dave, Kimberly McFarland, Jamshaid Mir, Shaleen Vira, Bassel Diebo, Andrew J. Schoenfeld, Peter G Passias
  • Neurology (clinical)
  • Orthopedics and Sports Medicine

Study Design:

Retrospective cohort review


To develop a scoring system for predicting increased risk of post-operative complications in ASD surgery based on baseline nutritional and metabolic factors.


Endocrine and metabolic conditions have been shown to adversely influence patient outcomes, and may increase the likelihood of post-operative complications. The impact of these conditions has not been effectively evaluated in patients undergoing adult spinal deformity (ASD) surgery.


ASD patients ≥ 18 years with baseline (BL) and two-year (2Y) data were included. An internally cross-validated weighted equation using pre-operative laboratory and comorbidity data correlating to increased peri-operative complications was developed via Poisson regression. BMI categorization (normal, over/underweight, obese) and diabetes classification (normal, prediabetic, diabetic) were used per CDC and ADA parameters. A novel spine-specific metabolic burden score (ASD-NMBS) was calculated via Beta-Sullivan adjustment, and Conditional Inference Tree (CIT) determined score threshold for experiencing ≥1 complication. Cohorts were stratified into LOW and HIGH risk groups for comparison. Logistic regression assessed correlations between increasing burden score and complications.


201 ASD patients were included (mean age: 58.60±15.4, sex: 48% female, BMI: 29.95±14.31, CCI: 3.75± 2.40). Significant factors were determined to be: age (+1/year), hypertension (+18), peripheral vascular disease (+37), smoking status (+21), anemia (+1), VitD hydroxyl (+1 per ng/mL), BMI (+13/cat), and diabetes (+4/cat) (model: P<.001, AUC: 92.9%). CIT determined scores above 175 correlated with ≥ 1 post-op complication (P<.001). Furthermore, HIGH patients reported higher rates of post-operative cardiac complications (P=.045), and were more likely to require reoperation (P=.024) compared to LOW patients.


Development of a validated novel nutritional and metabolic burden score (ASD-NMBS) demonstrated that patients with higher scores are at greater risk of increased post-operative complications and course. As such, surgeons should consider reduction of nutritional and metabolic burden pre-operatively to enhance outcomes and reduce complications in ASD patients.

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