Impact of Nutritional Risk on Complications and Recovery in the Older People: A Geriatric Nutritional Risk Index-Based Study.

Introduction: The geriatric nutritional risk index (GNRI) has emerged as a useful predictor of surgical risk and postoperative outcomes. This study aimed to explore the utility of GNRI as a semiquantitative tool for predicting systemic and local complications after multilevel thoracolumbar fusion surgery in older patients and to evaluate the broader implications of nutritional status on postoperative recovery and independence. Methods: This multicenter study included 249 patients aged 65 years or older who underwent thoracolumbar fusion of at least four vertebrae. The nutrition-related risk grades were defined by the GNRI values, and the patients were divided into four groups: risk absent (GNRI >98), low risk (GNRI 92 to ≤98), moderate risk (GNRI 82 to <92), and major risk (GNRI <82). The occurrence of systemic complications, surgical site infection (SSI), length of stay in the hospital, place of discharge, and occurrence of proximal junctional kyphosis or failure (PJK/PJF) within 2 years after surgery were examined. Results: The risk-absent group consisted of 165 patients, the low-risk group of 40, the moderate-risk group of 36, and the major-risk group of eight. The incidence of any systemic complications (p=0.016), PJK/PJF (p<0.001), and hospital stay (p=0.028) significantly increased with worsening GNRI. Furthermore, the number of patients who were discharged home significantly decreased as GNRI worsened (p<0.001). SSI occurred most frequently in the risk-absent group (4.2%). Conclusions: The GNRI serves as a semiquantitative assessment tool that enables the identification of high-risk patients who may benefit from preoperative nutritional interventions.