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This study investigates how the Geriatric Nutritional Risk Index (GNRI) can predict outcomes after spinal deformity surgery in elderly patients.

April 1, 2026Open Access

Geriatric Nutritional Risk Index as a Predictor of Outcomes After Spinal Deformity Surgery in Elderly Patients

Puntos clave

This study investigates how the Geriatric Nutritional Risk Index (GNRI) can predict outcomes after spinal deformity surgery in elderly patients.
Retrospective analysis of ACS-NSQIP database from 2008 to 2023.
Assessment of patients aged 65 and older undergoing spinal deformity surgery.
Stratification of patients by GNRI scores into normal, malnourished, or severely malnourished.
Comparison of GNRI with modified Frailty Index and age for predicting perioperative outcomes.
Majority (78%) of patients had normal nutrition; 15.2% were malnourished and 6.8% severely malnourished.
Malnutrition correlated with higher odds of wound disruption (OR 3.3), prolonged mechanical ventilation (OR 2.2), and non-home discharge (OR 1.6).
GNRI showed superior ability to predict adverse outcomes compared to the modified Frailty Index and chronological age.

Resumen

Study Design Retrospective cohort study. Objectives The Geriatric Nutritional Risk Index (GNRI) is widely applied to evaluate malnutrition in older adults, yet its relevance in spinal deformity surgery is unclear. This study examined the relationship between nutritional status before surgery, as assessed by GNRI, and postoperative outcomes in geriatric patients undergoing spinal deformity surgery. Methods The 2008-2023 ACS-NSQIP database was queried for patients aged ≥65 years who underwent spinal deformity surgery. Patients were stratified by GNRI score: normal (>98), malnourished (92-98), or severely malnourished (<92). The independent association and predictive value of GNRI were assessed in comparison to the 5-item modified Frailty Index (mFI-5) and chronological age for perioperative outcomes, including length of stay, non-home discharge, and 30-day postoperative complications. Results A total of 2186 patients were included: 1705 (78%) had normal nutrition, 332 (15.2%) were malnourished, and 149 (6.8%) were severely malnourished. Malnourished status was independently associated with significantly greater odds of wound disruption (OR 3.3, P = .014), prolonged mechanical ventilation (OR 2.2, P = 0.019), postoperative transfusion (OR 1.5, P = .001), increased transfusion volume (coefficient 0.452, P = .044), and non-home discharge (OR 1.6, P < .001) compared to normal patients. In receiver operating characteristic analyses, GNRI demonstrated superior discriminatory ability compared with mFI-5 ( P = 0.394, P = .645, P = .179, P = .113, P = .014, P = .233) and age ( P = .277, P = .074, P = .039, P = .167, P < .001, P < .001) for predicting wound disruption, superficial surgical site infection, prolonged mechanical ventilation, unplanned intubation, the need for transfusion, and prolonged hospitalization. Conclusions Preoperative malnutrition, defined by GNRI, is correlated with a greater risk of adverse outcomes following spinal deformity surgery in older adults, highlighting the importance of incorporating nutritional assessment into preoperative evaluation in this population.

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