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CC BY-NC-ND 4.0 · Asian J Neurosurg 2022; 17(01): 011-016
DOI: 10.1055/s-0042-1749069
Original Article

Effect of Preoperative Serum Transthyretin Levels on Postoperative Clinical Results and Morbidity in Patients Undergoing Spinal Surgery

Bora Gürer
1   Department of Neurosurgery, Faculty of Medicine, İstinye University, İstanbul, Turkey
,
Kertmen Hayri
2   Neurosurgery Clinic, Ankara Dışkapı Yıldırım Beyazıt SUAM, University of Health Sciences, Ankara, Turkey
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Abstract

Introduction This study aims to investigate the effects of preoperative serum transthyretin (TTR) levels on surgical success, pain scores, and postoperative morbidity.

Methods Note that, in our clinic, 188 patients who were operated for spinal pathologies between June 2010 and January 2011 were included in this study. Blood samples were drawn from all patients on the morning of surgery and then serum TTR measurements were made. Demographic data of all patients were collected, and then their preoperative and postoperative neurological examinations, Karnofsky scores, visual analog scale (VAS) scores, Oswestry Disability Index (ODI) scores, postoperative infection and wound healing status, hospital stay, and morbidity levels were recorded and TTR levels were compared.

Results When preoperative TTR level of patients were low, their Karnofsky scores decreased, ODI scores increased, the early postoperative VAS and late postoperative VAS values increased, and the length of hospital stay was increased. Moreover, in patients with low TTR levels, postoperative Karnofsky scores were lower, postoperative ODI levels were higher, postoperative early and late VAS scores were higher, hospital stays were longer, peroperative complication rates were higher, wound infection rates were higher, the delay in wound site healing was higher, and the morbidity rate was higher.

Conclusion Consequently, preoperative low TTR levels have been reported to be an effective parameter that can be used to predict surgical results, wound infection and wound site healing status, perioperative complications, and morbidity in spinal surgery.

Keywords

spinal surgery - surgical results - transthyretin


Publikationsverlauf

Artikel online veröffentlicht:
21. Juni 2022

© 2022. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Ingbar SH. Pre-albumin: a thyroxinebinding protein of human plasma. Endocrinology 1958; 63 (02) 256-259
    CrossrefPubMedGoogle Scholar
  • 2 Fleming CE, Saraiva MJ, Sousa MM. Transthyretin enhances nerve regeneration. J Neurochem 2007; 103 (02) 831-839
    CrossrefPubMedGoogle Scholar
  • 3 Fleming CE, Mar FM, Franquinho F, Saraiva MJ, Sousa MM. Transthyretin internalization by sensory neurons is megalin mediated and necessary for its neuritogenic activity. J Neurosci 2009; 29 (10) 3220-3232
    CrossrefPubMedGoogle Scholar
  • 4 Lee MJ, Konodi MA, Cizik AM, Bransford RJ, Bellabarba C, Chapman JR. Risk factors for medical complication after spine surgery: a multivariate analysis of 1,591 patients. Spine J 2012; 12 (03) 197-206
    CrossrefPubMedGoogle Scholar
  • 5 Deyo RA, Cherkin DC, Loeser JD, Bigos SJ, Ciol MA. Morbidity and mortality in association with operations on the lumbar spine. The influence of age, diagnosis, and procedure. J Bone Joint Surg Am 1992; 74 (04) 536-543
    CrossrefPubMedGoogle Scholar
  • 6 Kalanithi PS, Patil CG, Boakye M. National complication rates and disposition after posterior lumbar fusion for acquired spondylolisthesis. Spine 2009; 34 (18) 1963-1969
    CrossrefPubMedGoogle Scholar
  • 7 Li G, Patil CG, Lad SP, Ho C, Tian W, Boakye M. Effects of age and comorbidities on complication rates and adverse outcomes after lumbar laminectomy in elderly patients. Spine 2008; 33 (11) 1250-1255
    CrossrefPubMedGoogle Scholar
  • 8 Carreon LY, Puno RM, Dimar II JR, Glassman SD, Johnson JR. Perioperative complications of posterior lumbar decompression and arthrodesis in older adults. J Bone Joint Surg Am 2003; 85 (11) 2089-2092
    CrossrefPubMedGoogle Scholar
  • 9 Cassinelli EH, Eubanks J, Vogt M, Furey C, Yoo J, Bohlman HH. Risk factors for the development of perioperative complications in elderly patients undergoing lumbar decompression and arthrodesis for spinal stenosis: an analysis of 166 patients. Spine 2007; 32 (02) 230-235
    CrossrefPubMedGoogle Scholar
  • 10 Lee DY, Lee SH, Jang JS. Risk factors for perioperative cardiac complications after lumbar fusion surgery. Neurol Med Chir (Tokyo) 2007; 47 (11) 495-500
    CrossrefPubMedGoogle Scholar
  • 11 Raffo CS, Lauerman WC. Predicting morbidity and mortality of lumbar spine arthrodesis in patients in their ninth decade. Spine 2006; 31 (01) 99-103
    CrossrefPubMedGoogle Scholar
  • 12 Vaidya R, Carp J, Bartol S, Ouellette N, Lee S, Sethi A. Lumbar spine fusion in obese and morbidly obese patients. Spine 2009; 34 (05) 495-500
    CrossrefPubMedGoogle Scholar
  • 13 Schoenfeld AJ, Ochoa LM, Bader JO, Belmont Jr PJ. Risk factors for immediate postoperative complications and mortality following spine surgery: a study of 3475 patients from the National Surgical Quality Improvement Program. J Bone Joint Surg Am 2011; 93 (17) 1577-1582
    CrossrefPubMedGoogle Scholar
  • 14 Beck FK, Rosenthal TC. Prealbumin: a marker for nutritional evaluation. Am Fam Physician 2002; 65 (08) 1575-1578
    PubMedGoogle Scholar
  • 15 Mears E. Outcomes of continuous process improvement of a nutritional care program incorporating TTR measurement. Clin Chem Lab Med 2002; 40 (12) 1355-1359
    CrossrefPubMedGoogle Scholar
  • 16 Veterans Affairs Total Parenteral Nutrition Cooperative Study Group. Perioperative total parenteral nutrition in surgical patients. N Engl J Med 1991; 325 (08) 525-532
    CrossrefPubMedGoogle Scholar
  • 17 Bozzetti F, Braga M, Gianotti L, Gavazzi C, Mariani L. Postoperative enteral versus parenteral nutrition in malnourished patients with gastrointestinal cancer: a randomised multicentre trial. Lancet 2001; 358 (9292): 1487-1492
    CrossrefPubMedGoogle Scholar
  • 18 Antoun S, Rey A, Béal J. et al. Nutritional risk factors in planned oncologic surgery: what clinical and biological parameters should be routinely used?. World J Surg 2009; 33 (08) 1633-1640
    CrossrefPubMedGoogle Scholar
  • 19 Shenkin A. Assessment of nutritional status - implications for nutritional support and hospitalization. Plasma Protein Monitor. 2005; 1: 9-11
    Google Scholar
  • 20 Brugler L, Stankovic A, Bernstein L, Scott F, O'Sullivan-Maillet J. The role of visceral protein markers in protein calorie malnutrition. Clin Chem Lab Med 2002; 40 (12) 1360-1369
    CrossrefPubMedGoogle Scholar
  • 21 Ingenbleek Y, Young V. Transthyretin (prealbumin) in health and disease: nutritional implications. Annu Rev Nutr 1994; 14: 495-533
    CrossrefPubMedGoogle Scholar
  • 22 Bernstein LH, Ingenbleek Y. Transthyretin: its response to malnutrition and stress injury. clinical usefulness and economic implications. Clin Chem Lab Med 2002; 40 (12) 1344-1348
    CrossrefPubMedGoogle Scholar
  • 23 Spiekerman AM. Proteins used in nutritional assessment. Clin Lab Med 1993; 13 (02) 353-369
    CrossrefPubMedGoogle Scholar
  • 24 Bernstein L, Pleban W. Prealbumin in nutrition evaluation. Nutrition 1996; 12 (04) 255-259
    CrossrefPubMedGoogle Scholar
  • 25 Bernstein LH, Leukhardt-Fairfield CJ, Pleban W, Rudolph R. Usefulness of data on albumin and prealbumin concentrations in determining effectiveness of nutritional support. Clin Chem 1989; 35 (02) 271-274
    CrossrefPubMedGoogle Scholar
  • 26 Pepersack T. Outcomes of continuous process improvement of nutritional care program among geriatric units. J Gerontol A Biol Sci Med Sci 2005; 60 (06) 787-792
    CrossrefPubMedGoogle Scholar
  • 27 Reimund JM, Arondel Y, Escalin G, Finck G, Baumann R, Duclos B. Immune activation and nutritional status in adult Crohn's disease patients. Dig Liver Dis 2005; 37 (06) 424-431
    CrossrefPubMedGoogle Scholar
  • 28 Bernstain L. Prealbumin in Nutritional Care Consensus Group. Measurement of visceral protein status in assessing protein and energy malnutrition: standard of care. Nutrition 1995; 11 (02) 169-171
    Google Scholar
  • 29 Devoto G, Gallo F, Marchello C. et al. Prealbumin serum concentrations as a useful tool in the assessment of malnutrition in hospitalized patients. Clin Chem 2006; 52 (12) 2281-2285
    CrossrefPubMedGoogle Scholar
  • 30 Symreng T, Anderberg B, Kågedal B, Norr A, Schildt B, Sjödahl R. Nutritional assessment and clinical course in 112 elective surgical patients. Acta Chir Scand 1983; 149 (07) 657-662
    PubMedGoogle Scholar
  • 31 dos Santos Junqueira JC, Cotrim Soares E, Rodrigues Corrêa Filho H, Fenalti Hoehr N, Oliveira Magro D, Ueno M. Nutritional risk factors for postoperative complications in Brazilian elderly patients undergoing major elective surgery. Nutrition 2003; 19 (04) 321-326
    CrossrefPubMedGoogle Scholar
  • 32 Geisler JP, Linnemeier GC, Thomas AJ, Manahan KJ. Nutritional assessment using prealbumin as an objective criterion to determine whom should not undergo primary radical cytoreductive surgery for ovarian cancer. Gynecol Oncol 2007; 106 (01) 128-131
    CrossrefPubMedGoogle Scholar
  • 33 Jewell L, Guerrero R, Quesada AR, Chan LS, Garner WL. Rate of healing in skin-grafted burn wounds. Plast Reconstr Surg 2007; 120 (02) 451-456
    CrossrefPubMedGoogle Scholar
  • 34 Nakamura K, Moriyama Y, Kariyazono H. et al. Influence of preoperative nutritional state on inflammatory response after surgery. Nutrition 1999; 15 (11-12): 834-841
    CrossrefPubMedGoogle Scholar
  • 35 Richardson DL, Mariani A, Cliby WA. Risk factors for anastomotic leak after recto-sigmoid resection for ovarian cancer. Gynecol Oncol 2006; 103 (02) 667-672
    CrossrefPubMedGoogle Scholar
  • 36 Donato D, Angelides A, Irani H, Penalver M, Averette H. Infectious complications after gastrointestinal surgery in patients with ovarian carcinoma and malignant ascites. Gynecol Oncol 1992; 44 (01) 40-47
    CrossrefPubMedGoogle Scholar
  • 37 Moghazy AM, Adly OA, Abbas AH, Moati TA, Ali OS, Mohamed BA. Assessment of the relation between prealbumin serum level and healing of skin-grafted burn wounds. Burns 2010; 36 (04) 495-500
    CrossrefPubMedGoogle Scholar
  • 38 Carson SN, Overall K, Lee-Jahshan S, Travis E. Vacuum-assisted closure used for healing chronic wounds and skin grafts in the lower extremities. Ostomy Wound Manage 2004; 50 (03) 52-58
    PubMedGoogle Scholar
  • 39 Salvetti DJ, Tempel ZJ, Goldschmidt E. et al. Low preoperative serum prealbumin levels and the postoperative surgical site infection risk in elective spine surgery: a consecutive series. J Neurosurg Spine 2018; 29 (05) 549-552
    CrossrefPubMedGoogle Scholar
  • 40 Gao C, Zhang B, Zhang W, Pu S, Yin J, Gao Q. Serum prealbumin (transthyretin) predict good outcome in young patients with cerebral infarction. Clin Exp Med 2011; 11 (01) 49-54
    CrossrefPubMedGoogle Scholar
  • 41 Santos SD, Lambertsen KL, Clausen BH. et al. CSF transthyretin neuroprotection in a mouse model of brain ischemia. J Neurochem 2010; 115 (06) 1434-1444
    CrossrefPubMedGoogle Scholar
  • 42 Bastianetto S, Brouillette J, Quirion R. Neuroprotective effects of natural products: interaction with intracellular kinases, amyloid peptides and a possible role for transthyretin. Neurochem Res 2007; 32 (10) 1720-1725
    CrossrefPubMedGoogle Scholar
  • 43 Serot JM, Christmann D, Dubost T, Couturier M. Cerebrospinal fluid transthyretin: aging and late onset Alzheimer's disease. J Neurol Neurosurg Psychiatry 1997; 63 (04) 506-508
    CrossrefPubMedGoogle Scholar
  • 44 Fleming CE, Nunes AF, Sousa MM. Transthyretin: more than meets the eye. Prog Neurobiol 2009; 89 (03) 266-276
    CrossrefPubMedGoogle Scholar