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The Impact of Malnutrition on Open Intracranial Aneurysm Surgery Outcomes in Adults: A Large Propensity-Matched Retrospective Cohort Study

Friday, May 3, 2024

    Presenting Author(s)

  • Nischal Acharya, BSc (he/him/his)

    Medical Student/Junior Research Specialist/Spine Research Fellow
    University of California, Irvine - Department of Neurological Surgery
    Orange, CA, US

    • Co-Author(s)

  • Jessica Campos, MD (she/her/hers)

    Resident, PGY-5
    Department of Neurological Surgery, University of California, Irvine
    Orange, California, United States

  • FH

    Frank P.K. Hsu, MD, PhD

    Chair of the UCI Department of Neurosurgery
    Department of Neurological Surgery, University of California, Irvine, UCI Medical Center, Orange, CA
    Orange, California, United States

  • MO

    Michael Oh, MD

    Clinical Professor of Neurological Surgery
    University of California, Irvine
    Orange, California, United States

  • AR

    Ashish Ramesh, BSc

    Medical Student
    UC Irvine School of Medicine, United States

Introduction: Malnutrition, defined as albumin < 3.5 g/dL, is a preoperative risk factor linked to postoperative complications. However, there is a paucity of data regarding its effect on patients undergoing open intracranial aneurysm surgery. As such, an understanding of the specific complications associated with malnutrition in this setting has the potential to inform guidelines for nutritional optimization.

Methods: Retrospective data was retrieved from the TriNetX database from 60 healthcare organizations for patients aged 18 to 90 undergoing open intracranial aneurysm operation between 2003 and 2023 with serum albumin collected within 4 months of surgery. Malnourishment was defined as serum albumin below 3.5 g/dL. Cohorts were generated with propensity matching. From an initial population of 938 malnourished and 3436 nourished patients, propensity score matching generated two cohorts of 875 patients each. Outcomes were retrieved for the 1 day, 1 month, and 3-month time points. Differences were examined via a t-test for incidence risk and survival analysis with a log-rank test for differences in outcome probability.

Results: At 1-month, significant differences were noted for readmission (36.0% vs 29.0%, p = 0.001), death (8.9% vs 4.3%, p = 0.001), wound infection (4.7% vs 1.7%, p = 0.001), nontraumatic hemorrhage (19% vs 14%, p = 0.002), pneumonia (15% vs 10%, p = 0.001), ventilator use (22.5% vs 15%, p = 0.001), acute pulmonary failure (4.5% vs 3.4%, p = 0.035), dysphagia with abnormal swallow study (5.7% vs 3.1%, p = 0.005), new onset seizures (6.9% vs 4.1%, p = 0.004), and coma (10% vs 6.7%, p = 0.006). These differences remained significant at 3 months.

Conclusion : Markers of malnutrition may have a significant negative association with outcomes in the setting of open intracranial aneurysm surgery. Future prospective studies are needed to guide specific recommendations for nutritional optimization in these patients.